Outpatient Alcohol Research Articles

OCDS Craving Scores Predict 24-Month Outcome in Alcoholic Outpatients

This study was conducted to replicate previous findings on the predictive value of a German version of the Obsessive Compulsive Drinking Scale (OCDS) by investigating 24-month treatment outcome in an outpatient setting. This was a prospective, observational study with 92 alcohol-dependent patients. The OCDS was used to assess craving at the end of treatment, and at the 6-, 12-, and 24-month follow-ups. Univariate and logistic regression analyses were performed. Of the 67 patients interviewed at the 24-month follow-up, 58% were abstinent and 79% improved. OCDS scores were higher in patients with a less favorable outcome. In line with previous findings, our results showed that the intensity of craving as measured by the OCDS may predict outcome in outpatient alcoholics.

Personality Disorders among Alcoholic Outpatients: Prevalence and Course in Treatment

To determine the prevalence of concurrent personality disorders (PDs) among alcoholic men and women seeking outpatient treatment, and to examine their effect on the course of alcohol treatment. Patients with alcohol use disorders (n = 165) were assessed by clinical and semi-structured interviews, as well as self-report scales, to measure levels of psychological distress, impulsivity, social functioning, and addiction severity at treatment intake. PD diagnoses were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Personality Disorder (SCID-II). Course in treatment was monitored prospectively for 12 weeks. Using the results of the SCID-II (n = 138), the sample was divided into 3 groups-that is, no PD 41% (n = 57), Cluster B PD 32% (n = 44), and other PD 27% (n = 37). The 3 groups did not differ in their alcohol use severity at intake. However, the Cluster B PD group achieved alcohol milestones at a younger age. Subjects with a PD had more severe psychological and social problems at intake. The Cluster B PD group showed significantly higher levels of impulsivity at intake, greater likelihood of early treatment dropout, and quicker times to first slip and to relapse. This study supports the high prevalence of concurrent PDs, particularly Cluster B PDs, among treatment-seeking alcoholics. The relation between observed high levels of impulsivity and worse course in early alcohol treatment among people with a Cluster B PD merits further investigation.

Alcohol-dependent patients receiving specialised outpatient care: an overview of gender issues

OBJECTIVE: The objective of the present study, with focus on gender, was aimed at evaluating alcohol-dependent individual in terms of socio-demographic variables related to alcohol consumption and therapeutic interventions. METHODS: This is a retrospective cross-sectional study of 1,051 patients (833 men and 218 women), with diagnosis of alcohol dependence syndrome, according to ICD-10 criteria, who had sought treatment for the first time at a specialised health centre between 2000 and 2006. RESULTS: The results showed that women, compared to men, are more likely to be unemployed and without partner, in addition to having higher educational level, latter age of alcohol initiation, needing less outpatient alcohol detoxification program, consuming more fermented beverage, presenting less psychiatric comorbidities, and using less coadjutant medications during treatment. CONCLUSION: We can state that some peculiarities exist permeating both gender and alcohol consumption. A further focus on the characteristics of each population is needed to facilitate the adequate use of therapeutic interventions according to gender specificities.

Progress and compliance in alcohol abuse treatment

Improving patient compliance with physicians’ treatment or prescription recommendations is an important goal in medical practice. We examine the relationship between treatment progress and patient compliance. We hypothesize that patients balance expected benefits and costs during a treatment episode when deciding on compliance; a patient is more likely to comply if doing so results in an expected gain in health benefit. We use a unique data set of outpatient alcohol abuse treatment to identify a relationship between treatment progress and compliance. Treatment progress is measured by the clinician's comments after each attended visit. Compliance is measured by a client attending a scheduled appointment, and continuing with treatment. We find that a patient who is making progress is less likely to drop out of treatment. We find no evidence that treatment progress raises the likelihood of a patient attending the next scheduled visit. Our results are robust to unobserved patient heterogeneity.

Smoking cessation during alcohol treatment: a randomized trial of combination nicotine patch plus nicotine gum

The primary aim was to compare the efficacy of smoking cessation treatment using a combination of active nicotine patch plus active nicotine gum versus therapy consisting of active nicotine patch plus placebo gum in a sample of alcohol-dependent tobacco smokers in an early phase of out-patient alcohol treatment. A secondary aim was to determine whether or not there were any carry-over effects of combination nicotine replacement on drinking outcomes. Small-scale randomized double-blind placebo-controlled clinical trial with 1-year smoking and drinking outcome assessment. Two out-patient substance abuse clinics provided a treatment platform of behavioral alcohol and smoking treatment delivered in 3 months of weekly sessions followed by three monthly booster sessions. Participants were 96 men and women with a diagnosis of alcohol abuse or dependence and smoking 15 or more cigarettes per day. All participants received open-label transdermal nicotine patches and were randomized to receive either 2 mg nicotine gum or placebo gum under double-blind conditions. Analysis of 1-year follow-up data revealed that patients receiving nicotine patch plus active gum had better smoking outcomes than those receiving patch plus placebo gum on measures of time to smoking relapse and prolonged abstinence at 12 months. Alcohol outcomes were not significantly different across medication conditions. Results of this study were consistent with results of larger trials of smokers without alcohol problems, showing that combination therapy (nicotine patch plus gum) is more effective than monotherapy (nicotine patch) for smoking cessation.

Engagement and retention in outpatient alcoholism treatment for women.

Reviews of the dropout literature note significant attrition from addiction treatment. However, consistent predictors have not been identified and few studies have examined factors related to retention and engagement for women in gender-specific treatment. The current study consisted of 102 women and their partners randomized to individual or couples outpatient alcoholism treatment. Women attended more treatment sessions if they were assigned to individual treatment, older, had fewer symptoms of alcohol dependence, had more satisfying marital relationships, had spouses who drank, and had matched preference for treatment condition. Women were more engaged in treatment (ie, completed more assigned homework) if they had fewer children at home, fewer alcohol dependence symptoms, later age of onset of alcohol diagnosis, more satisfying marital relationships, and spouses who accepted or encouraged their drinking. Results highlight important associations of treatment and relationship variables with treatment retention and engagement.

Outpatient alcoholism treatment – 24-month outcome and predictors of outcome

ObjectivesTo study the value of demographic and alcohol-related variables for predicting 24-month treatment outcome in an outpatient setting.MethodsProspective observational study with 92 alcohol-dependent patients. Assessments were made by personal interviews at the beginning and end of therapy, and at the 24-month follow-up. Univariate and logistic regression analyses were performed.Results: The mean age was 46.0 (SD = 9.9) years. There were 58 males (65.2%) and 31 females (34.8%). Of the 67 patients interviewed at 2-year follow-up, 58% were abstinent and 79% improved. Differences between abstainers and non-abstainers were found for number of previous detoxifications, and number of patients attempted suicides. In addition, female gender and a higher number of prior treatments predicted negative treatment outcome.ConclusionMatching patients to different types of treatment by means of empirically based characteristics may help to improve outcome but research has failed to establish reliable predictors in that area. Data from this follow-up study confirm the role of certain clinical outcome predictors. Additionally, results give further evidence for outpatient treatment as an effective setting for alcohol-dependent patients as indicated by a favourable retention rate (84%) and outcome (minimum abstinence rate 44%).

Parent Training With Behavioral Couples Therapy for Fathers' Alcohol Abuse

This pilot study examined effects of Parent Skills with Behavioral Couples Therapy (PSBCT) on substance use, parenting, and relationship conflict among fathers with alcohol use disorders. Male participants (N = 30) entering outpatient alcohol treatment, their female partners, and a custodial child (8 to 12 years) were randomly assigned to (a) PSBCT; (b) Behavioral Couples Therapy (BCT); or (c) Individual-Based Treatment (IBT). Children were not actively involved in treatment. Parents completed measures of substance use, couples' dyadic adjustment, partner violence, parenting, and Child Protection Services (CPS) involvement at pretreatment, posttreatment, 6- and 12-month follow-up. PSBCT was comparable to BCT on substance use, dyadic adjustment, and partner violence; both groups showed clinically meaningful effects over IBT. Compared to BCT, PSBCT resulted in larger effect sizes on parenting and CPS involvement throughout follow-up. PSBCT for fathers may enhance parenting couple- or individual-based treatment, and warrant examination in a larger, randomized efficacy trial.

The Relationship Between Relapse to Alcohol and Relapse to Violence

The purpose of this investigation was to examine levels of intimate partner violence (IPV) in partner-violent men after leaving alcohol treatment and the interrelationship between relapse to alcohol and re-occurrence of IPV. The primary research question under investigation was whether the time to relapse to violence was related to the male partner’s relapse to drinking after outpatient alcoholism treatment. This investigation also considered the potential moderating effects of female partner drinking and anti-social personality disorder (ASPD) and whether relapse to alcohol is associated with different levels of IPV severity. A survival analysis was conducted to assess the time to relapse to violence after treatment. Findings revealed significant differences indicating those subjects that relapsed to alcohol were much more likely to relapse to physical aggression. For males diagnosed with ASPD, the effect of relapse to drinking was more prominent for nonsevere intimate partner violence. Finally, findings revealed that female alcohol consumption increased the likelihood of victimization by various degrees depending upon her severity of alcohol consumption. Results of this study suggest that when partner-violent men who complete alcoholism treatment relapse to alcohol, they are also likely to relapse to violence.

Providing Post-Treatment Support in an Outpatient Alcohol and Other Drug Treatment Context: A Qualitative Study of Staff Opinion

This paper examines the post-treatment support practices, attitudes and preferences of outpatient alcohol and other drug (AOD) treatment staff as well as perceived barriers to implementing a post-treatment support service in an outpatient AOD treatment context. Data were collected via semi-structured interview and group discussion (n = 23). Findings suggest that post-treatment support was rarely provided by participating AOD treatment staff or their respective services. However, there was widespread support for implementing such services, and it was generally believed that implementation would be most successful if: multiple post-treatment support options were made available; if one or more of these options were based on the maintenance of an established client/clinician relationship; and if one of the options involved proactive (service-led) telephone support. A number of barriers to possible implementation were identified, although none were considered insurmountable.

Serum Proteomic Profiles in Subjects with Heavy Alcohol Abuse

OBJECTIVES: The abuse of alcohol is a major public health problem, and the diagnosis and care of patients with alcohol abuse and dependence is hindered by the lack of tests that can detect dangerous levels of drinking or relapse during therapy. Gastroenterologists and other healthcare providers find it very challenging to obtain an accurate alcohol drinking history. We hypothesized that the effects of ethanol on numerous systems may well be reflected in changes in quantity or qualities of constituent or novel plasma proteins or protein fragments. Organ/tissue-specific proteins may be released into the blood stream when cells are injured by alcohol, or when systemic changes are induced by alcohol, and such proteins would be detected using a proteomic approach. The objective of this pilot study was to determine if there are plasma proteome profiles that correlate with heavy alcohol use. METHODS: Paired serum samples, before and after intensive alcohol treatment, were obtained from subjects who attended an outpatient alcohol treatment program. Serum proteomic profiles using MALDI -OTOF Mass Spectrometry were compared between pre- and post treatment samples. RESULTS: Of 16 subjects who enrolled in the study, 8 were females. The mean age of the study subjects was 49 yrs. The baseline laboratory data showed elevated AST (54 ± 37 IU/L), ALT (37 ± 19 IU/L), and MCV (99 ± 5 fl). Self-reported pre-treatment drinking levels for these subjects averaged 17 ± 7drinks/day and 103 ± 37 drinks/week. Mass spectrometry analyses showed a novel 5.9 kDa protein, a fragment of alpha fibrinogen, isoform 1, that might be might be a new novel marker for abusive alcohol drinking. CONCLUSIONS: We have shown in this pilot study that several potential protein markers have appeared in mass spectral profiles and that they may be useful clinically to determine the status of alcohol drinking by MALDI -OTOF mass spectrometry, especially a fragment of alpha fibrinogen, isoform 1. However, a large-scale study is needed to confirm and validate our current results.

Acceptance and Therapeutic Practice of Controlled Drinking as an Outcome Goal by Swiss Alcohol Treatment Programmes

Sixty-one percent (138/226) of Swiss inpatient and outpatient alcohol treatment programmes responded to a postal survey designed to assess the definition and acceptance of controlled drinking (CD) as a treatment objective, the degree to which a client’s severity of dependence and finality of CD as an outcome goal were associated with acceptance, and the perceived value of selected client characteristics when making treatment recommendations. CD was acceptable to large proportions of both outpatient services and inpatient programmes, although willingness to recommend CD was associated with client characteristics such as selecting CD as intermediate versus final outcome goal, lower severity of dependence, not being pregnant and higher social stability. Information and individual therapy to help clients pursue a CD goal are commonly available in outpatient agencies and some inpatient programmes, but group counseling, cue exposure and wet house services are not typically available from Swiss programmes.

Predictors of illicit substance dependence among individuals with alcohol dependence.

Individuals with alcohol dependence (AD) are at increased risk for developing dependence on illicit and prescription drugs. The goal of this cross-sectional study was to identify factors associated with drug dependence among individuals with AD. The sample consisted of 855 adults from the Irish Affected Sib Pair Study of Alcohol Dependence who were treated in inpatient or outpatient alcohol treatment programs and met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for lifetime AD. We studied predictors of dependence on six classes of drugs: cannabis, sedatives, stimulants, cocaine, opioids, and hallucinogens. Potential predictors examined included gender, age, education, and socioeconomic status; the personality traits of extraversion, neuroticism, and novelty seeking; conduct disorder, major depressive disorder, nicotine dependence, age at onset of alcohol use, early illicit drug use, and parental AD. Nicotine dependence, depression that began before substance use, and drug use before age 19 each increased the risk for dependence on several substance classes. Male gender, younger age, maternal AD, fewer years of education, higher neuroticism scores, conduct disorder, and early alcohol use each increased the risk of dependence on one or more substance classes. Among individuals in treatment for AD, cigarette smoking, early onset of major depression, and early drug use were associated with increased risk for drug dependence. These results suggest individuals with these risk factors may benefit from more intensive screening to prevent the onset of or to identify and treat drug dependence.

Facilitating involvement in Alcoholics Anonymous during out‐patient treatment: a randomized clinical trial

This study evaluated two strategies to facilitate involvement in Alcoholics Anonymous (AA)--a 12-Step-based directive approach and a motivational enhancement approach--during skills-focused individual treatment. Randomized controlled trial with assessments at baseline, end of treatment and 3, 6, 9 and 12 months after treatment. PARTICIPANTS, SETTING AND INTERVENTION: A total of 169 alcoholic out-patients (57 women) assigned randomly to one of three conditions: a directive approach to facilitating AA, a motivational enhancement approach to facilitating AA or treatment as usual, with no special emphasis on AA. Self-report of AA meeting attendance and involvement, alcohol consumption (percentage of days abstinent, percentage of days heavy drinking) and negative alcohol consequences. Participants exposed to the 12-Step directive condition for facilitating AA involvement reported more AA meeting attendance, more evidence of active involvement in AA and a higher percentage of days abstinent relative to participants in the treatment-as-usual comparison group. Evidence also suggested that the effect of the directive strategy on abstinent days was mediated partially through AA involvement. The motivational enhancement approach to facilitating AA had no effect on outcome measures. These results suggest that treatment providers can use a 12-Step-based directive approach to effectively facilitate involvement in AA and thereby improve client outcome.

Comparison of the Quick Drinking Screen and the Alcohol Timeline Followback with Outpatient Alcohol Abusers*

Objective: A recent study comparing the Quick Drinking Screen (QDS) with the Timeline Followback (TLFB) found that in a nonclinical population of problem drinkers both measures produced reliable summary measures of drinking. The current study was designed to replicate these findings with a clinical population of alcohol abusers. The data were collected over three years (2004–2006). Method: Participants were 124 alcohol abusers who voluntarily enrolled for outpatient treatment. Over half (52.4%) were female with an average age of almost 40 years. About a third were married, had completed university, and a quarter were unemployed and nonwhite. Participants reported having a drinking problem for an average of 8.3 years, and reported drinking on about 5 days per week, averaging six drinks per drinking day. On two different occasions, they responded to two different sets of questions about their alcohol use. The instruments were: (a) the Quick Drinking Screen (QDS), a summary drinking measure, administered by telephone prior to the assessment; and (2) the TLFB self-administered by computer at the assessment. Results: As in a previous study, this study found that the QDS and the TLFB, two very different drinking measures, collected similar aggregate drinking data for four drinking variables in a clinical sample of alcohol abusers. Conclusions: When it is not necessary or not possible to gather detailed drinking data, the QDS produces reliable brief summary measures of drinking for problem drinkers. Generalization to nonclinical samples awaits further research.

Gender differences in high-risk situations for drinking: Are they mediated by depressive symptoms?

Objective The purpose of the present study was to examine gender differences in the frequency of high-risk drinking situations and to investigate the extent to which depressive symptoms mediate the relationship. Method Participants were 143 outpatient alcohol treatment seekers. Each participant completed the Beck Depression Inventory-II and Inventory of Drug-Taking Situations (IDTS) at baseline prior to treatment. Results: Multivariate analysis of variance was used to examine gender differences in drinking across eight categories of situations assessed on the IDTS. Mediational analyses tested whether gender differences on these IDTS subscales may be mediated by depressive symptoms. We found support for the hypothesis that women report drinking more than men in response to unpleasant emotions and conflict with others, and that these associations are significantly mediated by depression severity. Conclusions The current findings have important implications for appropriate treatment for alcohol-dependent women. In particular, such treatment should include training in affect regulation and interpersonal skills, as well as treatment for depression, when appropriate.

Adherence with naltrexone prescription advice in hospital outpatient alcohol rehabilitation programme

Background: The anti-craving drug, naltrexone, is used as a pharmacotherapeutic adjunct in the treatment of alcohol dependence. In addictive disorders, compliance issues remain central. There are limited data on compliance with naltrexone treatment regimens within formalized rehabilitation programs and even less data that identifies factors that have an impact on this. Objective: To study patient adherence to naltrexone medication regimens and examine whether patients’ reported pre-treatment alcohol use, dependence severity and measures of psychological health are predictive of medication compliance. Method: Fifty outpatients meeting DSM IV criteria for alcohol dependence enrolled in a 12-week rehabilitation programme. This included cognitive behavioural therapy (CBT) and naltrexone, 50 mg orally daily. Measures included: pharmacy prescription pick-up including number of tablets dispensed, programme attendance and patient pre-treatment alcohol use variables. Measures of psychological health included somatic symptoms, anxiety, social dysfunction and depression as measured by the General Health Questionnaire (GHQ-28). Results: Classifying the sample into compliant (≥90% medication pick-up) and less compliant groups, 66% of subjects were naltrexone-compliant. Pre-treatment alcohol use variables were not predictive of compliance. Although social dysfunction and depression tended towards poorer prescription filling, measures of psychological distress (GHQ-28) did not identify factors predictive of medication non-compliance. One patient withdrew from treatment because of naltrexone-induced dysphoria. Conclusion: Patients with alcohol dependence demonstrated high levels of anti-craving medication compliance, good rehabilitation programme participation and favourable outcomes. Naltrexone was well tolerated. Medication compliance in this study group compared well with those of other hospital populations with chronic disorders. Factors predictive of anti-craving medication compliance in alcohol dependence require further study.

Using Topiramate or Naltrexone for the Treatment of Alcohol‐Dependent Patients

To compare topiramate versus naltrexone in the treatment of alcohol dependence. A 6-month naturalistic, randomized and open-label, trial of topiramate versus naltrexone, with assessments at enrollment and after 3 and 6 months of treatment. The setting was an outpatient alcohol clinic. One hundred and two alcohol-dependent patients who had been drinking heavily during the past month were included. Two randomized groups were created. In one, naltrexone was used as the therapeutic agent and, in the other, topiramate was chosen as the therapeutic agent. Both groups received psychological relapse prevention therapy. Outcome was measured using tools that assessed alcohol intake, cravings, disability, and quality of life; changes in biomarkers of alcohol intake were also used. With all the data, a secondary composite measure was created in order to assess each patient's global alcohol intake and its consequences. Both groups showed substantial reduction in their drinking. Naltrexone patients had higher nicotine consumption throughout the study. Topiramate was better at reducing alcohol-related cravings throughout the study. Both treatments had a similar mean cost throughout the study. Both topiramate and naltrexone were efficacious in the treatment of alcohol dependence, and the treatment costs were similar. There is a trend for topiramate to be superior to naltrexone on critical measures of drinking; however, the study did not have adequate statistical power to establish this fact.

Readiness to Change Profiles in Two Different Groups of Alcohol/Other Drug Abusers in the United States and Finland

ABSTRACT Information on alcohol/other drug abusers' readiness to change is needed for the individual planning of treatment. We investigated the readiness to change profiles of Finnish and North American alcohol/other drug abusers. The Finnish subjects (N = 780) were unselected alcoholics and polydrug users receiving inpatient treatment. The North American subjects (N = 946) were selected outpatient alcoholics treated on Project MATCH. Readiness to change was measured with the URICA (University of Rhode Island Change Assessment Scale). In the cluster analyses the subjects were placed in groups. The findings indicated that the readiness to change profiles of Americans and Finns are similar in form, but there were quantitative differences in grouping. The Finns' profiles were more often of the type resisting change compared to those of the Americans. These differences are most likely due to the fact that the Finnish subjects were unselected inpatients whereas the Americans were selected outpatients. The article considers the significance of the findings in the light of earlier profile studies and the treatment of alcohol/other drug abuse.

Providing Post-treatment Support in an Outpatient Alcohol and other Drug Treatment Context: A Survey of Client Opinion

This paper presents findings from a survey that sought the post-treatment support preferences of a group of outpatient alcohol and other drug treatment clients. The client group (n = 83) were presented with six possible models of post-treatment support and were asked to express their level of interest in using or receiving each model and, if interested, by what means they could best be provided. The six models included a range of pro-active (service initiated) and passive (client initiated) support services, variously accessible by telephone, mail, text-message, computer or in-person. Participants were also afforded an opportunity to identify alternative approaches. The results suggest pro-active telephone- and mail-based approaches to post-treatment support are favoured over passive in-person approaches and that computer and text-message approaches (whether passive or pro-active) may be least favourable in the contemporary environment.