Outpatient Treatment Of Alcohol Dependence Research Articles

Retention in outpatient treatment of alcohol dependence based on the Lesch`s typology and the involvement of a close person.

Retention in alcohol-dependence treatment is an indicator of successful treatment. The aim of this study was to analyze Lesch's typology of alcohol dependence (LAT) and the participation of close people as potential predictors of retention in outpatient treatment. Participants were included in the study according to the inclusion criteria. Data were collected over eight visits during a 6-month period. The primary outcome was retention in treatment during the 6-month follow-up period. 119 patients were involved in the study, and 84 (70.6 %) of those patients remained in treatment up to the 6th month. Analysis of retention was performed for the Lesch I, II, and III types, as the type IV patients were underrepresented and had different baseline characteristics. Higher retention was found for Lesch I type patients (78.4 %) in comparison to the merged II and III groups. The presence of close people at planned visits had a significant effect on treatment persistence. We found no significant difference in the treatment retention of alcohol-dependent patients at the 6-month follow-up. However, a more comprehensive survival analysis indicated a trend of different retention dynamics between the Lesch I and merged Lesch II and III subgroups. Baseline severity of dependence measured by AUDIT score had no significant effect on treatment retention (Tab. 1, Fig. 3, Ref. 35).

Anticonvulsants for the treatment of alcohol withdrawal syndrome and alcohol use disorders.

Alcoholic patients suffer from harmful allostatic neuroplastic changes in the brain causing an acute withdrawal syndrome upon cessation of drinking followed by a protracted abstinence syndrome and an increased risk of relapse to heavy drinking. Benzodiazepines have long been the treatment of choice for detoxifying patients and managing alcohol withdrawal syndrome (AWS). Non-benzodiazepine anticonvulsants (NBACs) are increasingly being used both for alcohol withdrawal management and for ongoing outpatient treatment of alcohol dependence, with the goal of either abstinence or harm reduction. This expert narrative review summarizes the scientific basis and clinical evidence supporting the use of NBACs in treating AWS and for reducing harmful drinking patterns. There is less evidence in support of NBAC therapy for AWS, with few placebo-controlled trials. Carbamazepine and gabapentin appear to be the most promising adjunctive treatments for AWS, and they may be useful as monotherapy in select cases, especially in outpatient settings and for the treatment of mild-to-moderate low-risk patients with the AWS. The body of evidence supporting the use of the NBACs for reducing harmful drinking in the outpatient setting is stronger. Topiramate appears to have a robust effect on reducing harmful drinking in alcoholics. Gabapentin is a potentially efficacious treatment for reducing the risk of relapse to harmful drinking patterns in outpatient management of alcoholism. Gabapentin's ease of use, rapid titration, good tolerability, and efficacy in both the withdrawal and chronic phases of treatment make it particularly appealing. In summary, several NBACs appear to be beneficial in treating AWS and alcohol use disorders.

Non-ETOH drug use among women in outpatient treatment for alcohol dependence

Non-ETOH drug use among women in outpatient treatment for alcohol dependence

Prognostic Factors During Outpatient Treatment for Alcohol Dependence: Cohort Study with 6 months of Treatment Follow-up

To identify prognostic factors to outpatient alcohol treatment on admission as well as during the treatment period. A cohort study of n = 209 alcoholic patients (DSM-IV) during 6 months of outpatient treatment. Eight medical doctors from two hospitals were involved. Co-responsible participation in treatment was a necessary condition. At admission, we documented socio demographic factors, use of other drugs and severity of alcohol consumption. During the 6 months, we observed medication for prevention of alcohol relapse [disulfiram (DIS), acamprosate], number of sessions with the doctor, number of phases of the consultation and medication for depression. Primary outcome variables were time to first heavy relapse and abstinence of heavy alcohol consumption. These were measured with Timeline Followback. Five or more alcohol units of 10 g in one relapse day were considered heavy relapse. The patients were 84% males, with 41 years median age; the median alcohol consumption was 192 g per day with a median duration of 13 years of heavy consumption. The median education was 6 years with 61% of the patients from lower socio-economic levels. The Kaplan-Meier heavy relapse rate at 6 months was 23%. On admission to treatment, female gender, lower socio-economic levels, cocaine use, >20 years of consumption, gamma glutamyl transferase values above normal and five or more alcohol-related problems on the Alcohol-Related Problem Questionnaire predicted worse outcomes. Having a full-time job and shorter abstinence time before treatment (until 7 days) predicted better outcomes. During the 6 months, we found that DIS for <120 days was a prognostic factor of worse outcomes. DIS for at least 120 days, >50% of adherence to consultations and more than two phases on each consultation predicted better outcomes. The combined sensitivity and specificity for DIS for at least 120 days, >50% of adherence to consultations and more than two phases on consultation regarding abstinence from heavy relapse were respectively 100 and 71%. During 6 months of outpatient treatment, longer adherence to DIS and consultations as well as more phases in a consultation involving necessarily a co-responsible predict a good outcome independently of the patient features at admission.

The Role of Therapeutic Alliance in Treatment for People with Mild to Moderate Alcohol Dependence

In an exploratory study of Therapeutic Alliance (TA) in brief outpatient treatment for alcohol dependence the relationship was investigated between TA and treatment outcome (measured at 6 weeks and 6 months) for 69 alcohol dependent clients participating in a randomised control trial between Motivational Enhancement Therapy and Non Directive Reflective Listening. TA was significantly higher for clients who attended all four sessions. The correlation between TA and change in per cent days abstinent (PDA) between baseline and 6 weeks approached significance. TA was significantly correlated with the Alcohol Problem Questionnaire (APQ) at 6 months and with change in APQ scores between baseline and 6 months. These relationships remained significant when treatment assignment was controlled for. Whilst there was a trend towards a relationship between TA and change in PDA between baseline and 6 months, this trend no longer remained when both treatment assignment and early change in drinking levels were controlled for. Therapeutic alliance may be a useful additional maker to predict outcome, but early treatment response appears to be a better predictor.

The effects of combined acamprosate and integrative behaviour therapy in the outpatient treatment of alcohol dependence: A randomized controlled trial

AimsThe aim of this randomized, controlled, multisite trial was to evaluate the efficacy of combined treatment with integrative behaviour therapy (IBT) and acamprosate on drinking behaviour in detoxified alcohol-dependent patients. MethodsA total of 371 patients were randomized to one of the three treatment conditions: IBT plus acamprosate, IBT plus placebo, or supportive counselling (‘treatment as usual’, TAU) plus acamprosate. The main outcome was success rate, i.e., rate of abstinence plus improvement according to the criteria of Feuerlein and Küfner (1989), at the end of the six-month treatment phase and at the subsequent six-month follow-up. Drinking status was validated by blood parameters (CDT, GGT, and MCV). Data were analyzed by an intent-to-treat model and missing data were classified as relapse. ResultsThe success rates at the end of treatment under both TAU plus acamprosate (37.7%) and IBT plus placebo (48%) almost reached the levels derived from the literature. However, adding acamprosate to IBT did not result in the expected increase in success rate (IBT plus acamprosate: 47.6%), and success rates did not differ significantly between groups. Similarly, there was no significant difference between treatment success rates at follow-up. ConclusionThe results suggest that the combination of acamprosate and IBT is not more effective than treatment with either IBT or acamprosate alone. However, the two acamprosate conditions differed in success rate by about 10%, which might constitute a clinically relevant though statistically non-significant effect.

Cost and Cost-effectiveness of the COMBINE Study in Alcohol-Dependent Patients

The COMBINE (Combined Pharmacotherapies and Behavioral Intervention) clinical trial recently evaluated the efficacy of medications, behavioral therapies, and their combinations for the outpatient treatment of alcohol dependence. The costs and cost-effectiveness of these combinations are unknown and of interest to clinicians and policy makers. To evaluate the costs and cost-effectiveness of the COMBINE Study interventions after 16 weeks of treatment. A prospective cost and cost-effectiveness study of a randomized controlled clinical trial. Eleven US clinical sites. One thousand three hundred eighty-three patients having a diagnosis of primary alcohol dependence. The study included 9 treatment groups; 4 groups received medical management for 16 weeks with naltrexone, 100 mg/d, acamprosate, 3 g/d, or both, and/or placebo; 4 groups received the same therapy as mentioned earlier with combined behavioral intervention; and 1 group received combined behavioral intervention only. Incremental cost per percentage point increase in percentage of days abstinent, incremental cost per patient of avoiding heavy drinking, and incremental cost per patient of achieving a good clinical outcome. On the basis of the mean values of cost and effectiveness, 3 interventions are cost-effective options relative to the other interventions for all 3 outcomes: medical management (MM) with placebo ($409 per patient), MM plus naltrexone therapy ($671 per patient), and MM plus combined naltrexone and acamprosate therapy ($1003 per patient). To our knowledge, this is only the second prospective cost-effectiveness study with a randomized controlled clinical trial design that has been performed for the treatment of alcohol dependence. Focusing only on effectiveness, MM-naltrexone-acamprosate therapy is not significantly better than MM-naltrexone therapy. However, considering cost and cost-effectiveness, MM-naltrexone-acamprosate therapy may be a better choice, depending on whether the cost of the incremental increase in effectiveness is justified by the decision maker.

Effectiveness of Sequential Combined Treatment in Comparison with Treatment as Usual in Preventing Relapse in Alcohol Dependence

The aim of this study was to compare the effectiveness of the sequential combined treatment (SCT) and treatment as usual (TU) in relapse prevention in a sample of alcohol-dependent patients, during 180 days of outpatient treatment. 209 alcohol-dependent patients who could attend with an informant adult were randomized to either TU or SCT. The primary outcome measure was time to first relapse, defined as the consumption of any amount of alcohol during the 180 days of follow-up. Secondary outcome measures included maximum duration of continuous abstinence (MDCA), cumulative abstinence duration (CAD), quality of life (ARPQ) and blood test markers of alcohol consumption. The SCT approach was more effective than TU. The Kaplan-Meier abstinent proportion at the end of the 180 days was 78% for the SCT group and 59% for the TU group (P<0.01). The mean time to first relapse was 150 days for SCT and 123 days for TU (P<0.01). The relative risk reduction of relapse was 62% for SCT after adjustment in multiple Cox regression (P<0.01). SCT had more MDCA (P<0.05) and more CAD (P<0.05). Therapy sessions lasted slightly longer for SCT than TU (mean 13 min versus 10 min). SCT can result in better outcomes than TU in the outpatient treatment of alcohol dependence.

Cost methodology of COMBINE.

This article describes the methodology used in estimating the mean cost per patient of the interventions delivered in COMBINE, a randomized controlled trial (RCT) comparing pharmacotherapies and behavioral interventions for outpatient treatment of alcohol dependence. Our methodology identifies a broad list of nonresearch activities necessary to implement the COMBINE interventions in standard clinical practice. For each activity, we include the time costs of clinical assessments and interventions by staff, the cost of space, laboratory charges and the cost of medical supplies. We also estimate the patients' time used for each of these activities. We present the estimated cost per activity for 15 intake assessments plus the Medical Management (MM) and Combined Behavioral Intervention (CBI) sessions for 9 of the 11 COMBINE sites. Labor costs represent the bulk of the total cost for all activities. The Form 90 AIR/ED is the most expensive intake activity both in terms of labor and space costs. The CBI session is more expensive than the MM session. Our methodology estimates the cost to treatment providers and to patients of implementing the COMBINE intervention in standard practice. Compared with previous methods, the prospective design of our methodology allows for higher quality data, and the detailed activity costing helps identify key cost drivers. Future analyses will present actual COMBINE intervention cost estimates based on trial data. Although this cost study is specific to the COMBINE interventions, the concepts, instruments and methods used here can be applied to any RCT.

Referral paths, patient profiles and treatment adherence of older alcoholic men

We sought factors affecting completion by older men of 1-year outpatient treatment for alcohol dependence. We retrospectively studied clinical datasets of 110 men, age ≥55 years, consecutively admitted over 4 years, examining the association of 18 referral, treatment and patient variables with completion of treatment. We found that referral source was the most significant correlate of completion. Legal and self/family referrals were far more likely to complete treatment than patients referred by health or social services. Referral groups had distinctive profiles. Legal referrals were the healthiest. Self/family referrals were most likely to be married, to have had prior alcoholism treatment (a factor also associated with treatment completion), and to suffer currently from depression. Health/social services referrals showed the highest levels of psychosocial and physical dysfunction. Referral pathways deserve special consideration by programs treating older alcoholics. Special strategies for engaging dysfunctional older patients in alcoholism treatment are discussed.

Marital Violence Victimization and Perpetration Among Women Substance Abusers

This study reports descriptive data assessing the impact of an intensive outpatient treatment for alcohol dependence on alcohol use, marital violence, psychological abuse, and marital satisfaction among 10 heterosexual female patients and their partners. Patients received 5 to 6 days of substance abuse treatment in a partial hospital program. Patient and partner assessments were conducted at baseline, 6-month follow-up, and 12-month follow-up. Results revealed decreased alcohol use in female patients as well as declines in the prevalence and frequency of husband-to-wife marital violence over time. Men evidenced no changes in their psychological abuse or marital satisfaction. Results also showed decreases in the prevalence and frequency of wife-to-husband violence and psychological abuse. Female patients reported no changes in their marital satisfaction. Overall, the study suggests that marital violence victimization and perpetration by female patients and their male partners declined following the females' substance abuse treatment. The clinical implications of the findings are discussed

A COMPARISON OF INPATIENT AND OUTPATIENT TREATMENT OF ALCOHOL DEPENDENCE

A COMPARISON OF INPATIENT AND OUTPATIENT TREATMENT OF ALCOHOL DEPENDENCE