The Impact of Alcohol Use on Drop-out and Psychological Treatment Outcomes in Improving Access to Psychological Therapies Services: an Audit.

J.E.J Buckman,S Pilling,S Linke,R Saunders,I Naismith,T Morrison,J Leibowitz

doi:10.1017/s1352465817000819

Abstract

The impact of alcohol use disorders (AUD) on psychological treatments for depression or anxiety in primary care psychological treatment services is unknown. To establish levels of alcohol misuse in an Improving Access to Psychological Therapies (IAPT) service, examine the impact of higher risk drinking on IAPT treatment outcomes and drop-out, and to inform good practice in working with alcohol misuse in IAPT services. 3643 patients completed a brief questionnaire on alcohol use pre-treatment in addition to measures of depression, anxiety and functioning. Symptom and functioning measures were re-administered at all treatment sessions. Severity of alcohol misuse was not associated with treatment outcomes, although those scoring eight or more on the AUDIT-C were more likely to drop out from treatment. IAPT services may be well placed to offer psychological therapies to patients with common mental disorders and comorbid AUD. Patients with AUD can have equivalent treatment outcomes to those without AUD, but some higher risk drinkers may find accessing IAPT treatment more difficult as they are more likely to drop out. Alcohol misuse on its own should not be used as an exclusion criterion from IAPT services. Recommendations are given as to how clinicians can: adjust their assessments to consider the appropriateness of IAPT treatment for patients that misuse alcohol, consider the potential impact of alcohol misuse on treatment, and improve engagement in treatment for higher risk drinkers.

Highlights

Alcohol use disorders (AUD) are highly comorbid with psychiatric conditions, with up to 85% of patients seen in alcohol disorder services reporting a comorbid psychiatric condition (Weaver et al, 2003)
Reasons for not completing the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) were not recorded; 115 (6.8%) of those not included were patients of another Improving Access to Psychological Therapies (IAPT) service that co-facilitates some group therapies with the audit service, and 38 (2.25%) were seen in partner organizations
Patients of these other services were not asked to complete the AUDIT-C so could not be included in the present audit but are kept in the comparison sample as their data are counted in the national reporting of the primary and secondary outcomes for the service as a whole

Summary

Introduction

Alcohol use disorders (AUD) are highly comorbid with psychiatric conditions, with up to 85% of patients seen in alcohol disorder services reporting a comorbid psychiatric condition (Weaver et al, 2003) This comorbidity contributes to patients being passed between specialist mental health services and specialist alcohol services, as well as a higher rate of patients declining treatment or failing to access treatment. IAPT services do not routinely offer treatment to address AUD, but national guidance for IAPT clinicians suggests that patients with comorbid substance misuse should have access to evidence-based psychological treatments for depression and anxiety (IAPT, 2012). Aims: To establish levels of alcohol misuse in an Improving Access to Psychological Therapies (IAPT) service, examine the impact of higher risk drinking on IAPT treatment outcomes and drop-out, and to inform good practice in working with alcohol misuse in IAPT services. Recommendations are given as to how clinicians can: adjust their assessments to consider the appropriateness of IAPT treatment for patients that misuse alcohol, consider the potential impact of alcohol misuse on treatment, and improve engagement in treatment for higher risk drinkers

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