Specialty Alcohol Treatment Research Articles

Was receipt of any specialty alcohol treatment during the pandemic effective at reducing drinking for patients with or at risk of AUD?

IntroductionThe COVID-19 pandemic changed the way healthcare providers delivered most health services, including treatment for alcohol use disorder (AUD). Specialty alcohol treatment remained available through the pandemic, and within some systems treatment use increased likely due to telehealth availability. However, the field knows little about the relationship between the pandemic's expanded access to specialty alcohol treatment and alcohol use outcomes. MethodsThe sample included 14,712 patients from Kaiser Permanente Northern California who screened positive for unhealthy alcohol use in primary care and had an AUD diagnosis or risked developing an AUD by reporting 5 or more heavy drinking days in a 3-month period between 1/1/2019 and 2/29/2020 (pre-pandemic). The study examined the receipt of any specialty alcohol treatment (including at least one outpatient, inpatient, or telehealth specialty treatment encounter, or pharmacotherapy prescription) from 3/1/2020 (pandemic start) to either the first completed follow-up alcohol screening or 6/20/2022 (study period end). The outcomes of alcohol use included changes in heavy drinking days, drinks per week, drinking days per week, and drinks per drinking day between the pre- and post-pandemic periods. ResultsOn average patients significantly decreased alcohol use across all four alcohol use measures examined, regardless of whether they received treatment. However, those who received any treatment compared to those who did not have greater reductions in alcohol use, with an additional decrease of −3.55 heavy drinking days (95 % CI = −5.93, −1.17), −3.80 drinks per week (95 % CI = −5.18, −2.42), −0.72 drinks per drinking day (95 % CI = −1.14, −0.30), and − 1.01 drinking days per week (95 % CI = −1.30, −0.72). Treatment effects were greatest among patients who exceeded both daily and weekly limits pre-pandemic, with an additional decrease of −10.75 heavy drinking days (95 % CI = −15.28, −6.21), −12.83 drinks per week (95 % CI = −16.31, −9.35), −1.67 drinks per drinking day (95 % CI = −2.19, −1.14), and −2.02 drinking days per week (95 % CI = −2.41, −1.63). ConclusionsOn average, patients decreased alcohol use during the onset of the pandemic, however, those who had any specialty alcohol treatment had significantly greater decreases, suggesting that the hybrid in-person and telehealth treatment approach was effective during the pandemic.

Barriers to AUD treatment for Latinos found in new measure

Compared with whites, Latinos perceive a lack of social support, logistical barriers, low treatment efficacy, cultural barriers, and immigration‐related concerns as obstacles to treatment for alcohol use disorder (AUD), according to researchers who tested a new measure, the “Barriers to Specialty Alcohol Treatment” (BSAT) scale.

Improving assessment of alcohol treatment barriers among Latino and White adults with an alcohol use disorder: Development of the barriers to specialty alcohol treatment scale

IntroductionThe present study’s aims were two-fold. First, we sought to validate a novel measure to assess barriers to specialty alcohol treatment among White and Latino individuals with an alcohol use disorder (AUD): The Barriers to Specialty Alcohol Treatment (BSAT) scale. Second, we sought to demonstrate that the BSAT scale could be used to explain Latino-White disparities in barriers to alcohol treatment. MethodsIn 2021, we recruited an online national sample of 1200 White and Latino adults with a recent AUD. Participants completed an online questionnaire that included the BSAT items. Confirmatory and exploratory factor analyses were conducted to validate the BSAT. Multiple group analyses across race/ethnicity and language were also performed using the final model. ResultsThe final model consisted of 36 items across 7 factors that reflect barriers related to low problem recognition, recovery goals, low perceived treatment efficacy, cultural factors, immigration-related concerns, low perceived social support, and logistical barriers. The final model’s factor structure and factor loadings held up across race/ethnicity and language. The top endorsed barriers were low problem recognition, recovery goals, low perceived social support, logistical issues, and low perceived treatment efficacy. Compared to Whites, Latinos were more likely to report perceived lack of social support, logistical barriers, low perceived treatment efficacy, cultural barriers, and immigration-related concerns as barriers. ConclusionFindings provide empirical support for the validity of the BSAT scale, which offers improved measurement of specialty alcohol treatment barriers and can be used to explore Latino-White disparities in a future study.

COVID-19 pandemic-related changes in utilization of telehealth and treatment overall for alcohol use problems.

During the COVID-19 pandemic, specialty alcohol treatment transitioned rapidly to telehealth, which may have created barriers for some patients but increased access for others. This study evaluated the impact of the COVID-19 pandemic on alcohol treatment utilization and potential disparities. We analyzed electronic health record and claims data from Kaiser Permanente Northern California for adults with alcohol use problems (alcohol use disorder or unhealthy alcohol use diagnoses) during pre-COVID-19 (March to December 2019, n=32,806) and COVID-19 onset (March to December 2020, n=26,763). Generalized estimating equation models were fit to examine pre-COVID-19 to COVID-19 onset changes in alcohol treatment initiation, engagement, and retention (days in treatment). Heterogeneity in pre-COVID-19 to COVID-19 onset changes in treatment utilization by age, race, and ethnicity; neighborhood deprivation index (NDI); and comorbid medical and psychiatric disorders were also examined. Treatment initiation increased during the COVID-19 onset period (adjusted odds ratio [aOR]=1.46; 95% CI=1.41-1.52). The increases in odds of treatment initiation during the COVID-19 onset period compared with the pre-COVID period were largest among patients aged 18-34 years (aOR=1.59; 95% CI=1.48-1.71), those without medical conditions (aOR=1.56; 95% CI=1.49-1.65), and those without psychiatric disorders (aOR=1.60; 95% CI=1.51-1.69). Patients aged 18-34 years (aOR=5.21; 95% CI=4.67-5.81), those with the second highest NDIs (aOR=4.63; 95% CI=4.12-5.19), and those without medical (aOR=4.34; 95% CI=4.06-4.65) or psychiatric comorbidities (aOR=4.48; 95% CI=4.11-4.89) had the greatest increases in telehealth treatment initiation from pre-COVID-19 to COVID-19 onset. Treatment engagement and retention also increased during COVID-19 onset, with the greatest increase among patients aged 35-49 years who initiated treatment via telehealth (engagement: aOR=2.33; 95% CI=1.91-2.83; retention: adjusted mean difference [aMD]=3.3 days; 95% CI=2.6-4.1). We found no significant variation of changes in treatment utilization by race and ethnicity. The transition to telehealth in this healthcare system may have attracted subgroups of individuals who have historically underutilized care for alcohol use problems, particularly younger and healthier adults, without exacerbating pre-pandemic racial and ethnic disparities in treatment utilization.

Can the AUDIT consumption items distinguish lower severity from high severity patients seeking treatment for alcohol use disorder?

Brief screening tools based on the Alcohol Use Disorders Identification Test (AUDIT) consumption items (e.g., AUDIT-C and AUDIT-3) are commonly used in general medical settings to identify at-risk drinkers who may benefit from alcohol interventions. Conversely, in specialty alcohol treatment settings with a high volume of self-referrals, there may be a need for brief screening tools that can help to identify patients who are unlikely to require intensive treatments, but there has been little research on the use of AUDIT-C or AUDIT-3 in this context. The current study examined the utility of brief screeners comprised of the AUDIT consumption items for distinguishing lower-severity patients from high severity patients in a cohort of individuals self-referring to specialty alcohol treatment. Participants were adults seeking treatment for alcohol problems (N = 853) at a large public psychiatric hospital in Toronto, Canada, who completed the full 10-item AUDIT as part of an initial telephone screening with hospital staff. Results of receiver operating characteristic curve analyses showed that both the AUDIT-C and the AUDIT-3 demonstrated adequate accuracy (area under the curve; AUC > 0.85) for distinguishing lower-severity patients (defined as those in AUDIT zones I, II, and III) from high-severity patients (defined as those in AUDIT zone IV). Exploratory analyses showed that the addition of AUDIT item 4 (impaired control) to the AUDIT-C and AUDIT-3 significantly improved classification accuracy (AUCs = 0.95; ps < .001), and the resulting brief screeners had cut-points with good sensitivity and specificity (i.e., >80%). Results support the potential utility of brief screeners comprised of the AUDIT consumption items for distinguishing lower-severity from high severity individuals seeking specialty alcohol treatment services, which may assist with the initial screening and triage process. The addition of AUDIT item 4 improved the performance of the AUDIT-C and AUDIT-3 in this context. Future research validating these findings against external criteria, including comprehensive diagnostic information, is required.

Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence?

Abstinence from alcohol has been the prevailing treatment goal for individuals with alcohol dependence (AD) within the context of specialty alcohol treatment. Yet, alcohol use has been conceptualized as existing on a continuum. Importantly, most people who meet criteria for AD and could benefit from treatment never receive treatment. About half of these individuals do not seek treatment because they report a desire to continue drinking. To increase acceptability of treatment, reductions in alcohol consumption have been examined as alternative outcomes in treatment trials for AD. The current study reviews data which indicate that long-term reduction in alcohol consumption among patients with AD is possible. Controlled studies have tested reduced alcohol consumption and show sustained improvements in drinking reductions for many patients following behavioral treatments and pharmacotherapy. Evidence-based treatment guidelines and medicines development guidance authorities have taken note of these developments and accept “intermediate harm reduction” (European Medicines Agency) or “low-risk drinking limits” (US Federal Drug Administration) as optional trial endpoints. In conclusion, while abstinence remains the safest treatment goal for individuals with AD, evidence supports that reduced drinking approaches may be an important extension in the treatment of AD.

Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial

BackgroundMost patients with alcohol use disorders (AUDs) never receive alcohol treatment, and experts have recommended management of AUDs in primary care. The Choosing Healthier Drinking Options In primary CarE (CHOICE) trial was a randomized controlled effectiveness trial of a novel intervention for primary care patients at high risk for AUDs. This report describes the conceptual and scientific foundation of the CHOICE model of care, critical elements of the CHOICE trial design consistent with the Template for Intervention Description and Replication (TIDieR), results of recruitment, and baseline characteristics of the enrolled sample.MethodsThe CHOICE intervention is a multi-contact, extended counseling intervention, based on the Chronic Care Model, shared decision-making, motivational interviewing, and evidence-based options for managing AUDs, designed to be practical in primary care. Outpatients who received care at 3 Veterans Affairs primary care sites in the Pacific Northwest and reported frequent heavy drinking (≥4 drinks/day for women; ≥5 for men) were recruited (2011–2014) into a trial in which half of the participants would be offered additional alcohol-related care from a nurse. CHOICE nurses offered 12 months of patient-centered care, including proactive outreach and engagement, repeated brief motivational interventions, monitoring with and without alcohol biomarkers, medications for AUDs, and/or specialty alcohol treatment as appropriate and per patient preference. A CHOICE nurse practitioner was available to prescribe medications for AUDs.ResultsA total of 304 patients consented to participate in the CHOICE trial. Among consenting participants, 90% were men, the mean age was 51 (range 22–75), and most met DSM-IV criteria for alcohol abuse (14%) or dependence (59%). Many participants also screened positive for tobacco use (44%), depression (45%), anxiety disorders (30-41%) and non-tobacco drug use disorders (19%). At baseline, participants had a median AUDIT score of 18 [Interquartile range (IQR) 14–24] and a median readiness to change drinking score of 5 (IQR 2.75–6.25) on a 1–10 Likert scale.ConclusionThe CHOICE trial tested a patient-centered intervention for AUDs and recruited primary care patients at high risk for AUDs, with a spectrum of severity, co-morbidity, and readiness to change drinking.Trial registration The trial is registered at clinicaltrial.gov (NCT01400581).

A moderating role for gender in racial/ethnic disparities in alcohol services utilization: results from the 2000 to 2010 national alcohol surveys.

Few nationally representative studies have examined racial/ethnic disparities in alcohol services utilization. Further, little is known about whether racial/ethnic disparities generalize across genders, and what factors account for these disparities. Thus, we aimed to describe the combined impact of race/ethnicity and gender on alcohol services utilization, and to explore the roles for social influence factors in explaining racial/ethnic and gender disparities. Data were pooled across the 2000, 2005, and 2010 National Alcohol Surveys. Outcomes included lifetime utilization of any services, specialty alcohol treatment, and Alcoholics Anonymous. Social influence factors were assessed as lifetime social pressures (i.e., pressures from a partner, friends, and/or family), legal consequences, and work-related consequences. Core analyses included only those with a lifetime alcohol use disorder (AUD). Analyses revealed a pattern of lower services utilization among Latinos and Blacks (vs. Whites) and women (vs. men); further, race-by-gender interactions revealed that Black-White differences were limited to women, and provided some evidence of stronger Latino-White disparities among women (vs. men). Illustrating these patterns, among women, only 2.5% of Latinas and 3.4% of Blacks with a lifetime AUD accessed specialty treatment, versus 6.7% of Whites; among men, corresponding figures were 6.8% for Latinos, 12.2% for Blacks, and 10.1% for Whites. Racial/ethnic differences were typically robust (or stronger) when controlling for demographics and AUD severity. Evidence did not support a role for measured social influence factors in racial/ethnic disparities, but did suggest that these factors contribute to gender disparities, particularly among Whites and Blacks. Findings for substantial Latino-White and Black-White disparities, especially among women, highlight the need for continuing research on explanatory factors and the development of appropriate interventions. Meanwhile, our evidence for persistent gender disparities and for social influence factors as drivers of these disparities tentatively suggests a need for intensified outreach to female heavy drinkers.

A brief video intervention to promote understanding of the neurobiological base of hazardous alcohol use and treatments

The majority (87.4%) of Americans who could benefit from specialty alcohol treatment reported they neither received nor perceived a need for treatment. Common reasons included not being ready to stop consuming alcohol, social stigma, pessimistic attitudes toward the effectiveness of treatment, and attitudinal factors such as minimizing the problem. Disseminating the neuroscience behind alcohol disorders to these at-risk individuals may reduce barriers to acceptance of referral to specialty alcohol treatment. A 20-minute DVD was developed for that purpose. The Transtheoretical Model served as the framework for this brief intervention with active ingredients of the brief intervention corresponding to one of the 10 processes of change. The purpose of this study was to assess the acceptability of, and change in knowledge after the brief intervention. A sample (n=11) of professional firefighters was selected because a previous study among this population found more than half (56%) reported binge drinking (56%) and 14% reported hazardous drinking. A 10-item knowledge test was administered before and immediately after the brief intervention. Mean knowledge scores increased significantly (t=7.72, p < 0.001) from pre- to post-test (43% to 84%, respectively). Acceptability of the video was affirmed from positive comments and interactive discussion following the viewing. This brief alcohol intervention may help shift the current paradigm of shame and blame to one that is consistent with other chronic health disorders (i.e., biologically-based) and otherwise help diminish the stigma that prevents individuals from engaging in alcohol-specialty treatment. This brief intervention is ready to be tested among individuals who are eligible for referral to substance abuse treatment. Intended outcomes will include reduction in alcohol consumption, acceptance of referral to treatment, engagement in treatment, and completion of that specialty treatment.

Community pharmacy-based alcohol brief intervention in the UK: significant alcohol consumption reduction in risky drinkers

Previous studies have shown that community-pharmacy– based screening and brief intervention (SBI) for risky alcohol use is feasible. However, few studies have reported significant reductions in alcohol use following pharmacy-delivered BI. In this study, trained pharmacists (N = 29) at 28 community pharmacies in London, UK, offered BI from February-July 2010. Customers seeking alcohol-related medication and/or advice were targeted. Participating pharmacists used Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores (≥3 for women and ≥4 for men), a seven-day drinking diary, and feedback on a readiness to change form to identify people with risky drinking and to inform appropriate advice and feedback. One in four community pharmacy customers (n = 246) offered the alcohol BI were initially interested, and half of these (n = 134, 87 of whom were men) received the intervention. Of the 128 customers whose alcohol use was recorded, 16% (n = 21) were classified as high-risk drinkers, 56% (n = 72) as increasingrisk drinkers, and 27% (n = 35) as low-risk drinkers. Three months following BI, low- and increasing-risk drinkers were contacted by a member of the study team to obtain a post-BI AUDIT-C score and to assess past seven-day alcohol consumption. High-risk drinkers were contacted to ascertain whether they had accessed specialty alcohol services. Seventy-five customers were available for follow-up (response rate, 56%). Of the high-risk drinkers, 91% (n = 10) had seen their general practitioner (GP) and/or accessed specialty alcohol services. Increasing-risk drinkers were found to have significantly reduced their weekly consumption (average decrease, 84%; p = 0.004) and number of drinking days (p = 0.05), however, no significant change in AUDIT-C score was observed. As anticipated, no significant differences in consumption were observed for low-risk drinkers. In this study, community-pharmacy–based alcohol SBI was effective in reducing weekly alcohol use among increasing-risk drinkers and facilitated contact between high-risk drinkers and their GPs and/or specialty alcohol treatment services.

Letter

Treatment of hazardous drinking can occur in either the primary care or specialty alcohol treatment sector, depending on disorder severity. Guidelines from the World Health Organization (WHO) (1) and the National Institute on Alcohol Abuse and Alcoholism (2) suggest that individuals with less severe disorders are appropriate candidates for primary care treatment with evidence-based interventions including Screening and Brief Interventions in which a clinician delivers a focused intervention to stop or reduce drinking. We estimated the percentage of individuals with hazardous drinking who might be appropriate candidates for primary care compared to those who require specialty care, using data from the second wave of the Healthcare for Communities survey (HCC2), conducted in 2000-2001 (3). HCC2 is uniquely positioned for this because it is nationally representative, and it includes the AUDIT (Alcohol Use Disorders Identification Test) (1), developed by the WHO to screen for hazardous drinking and to determine where treatment should be received (primary versus specialty care). Estimates of the percentage of the population with hazardous drinking who can be treated in primary care, and the proportion requiring specialty care, is vital for (1) assessing treatment appropriateness and triage of patients to the appropriate sector, and (2) allocating scarce behavioral health treatment and research resources. Our analysis was based on 7,893 respondents and was weighted to be representative of the adult United States population. (Percentages reported are weighted, actual counts are unweighted) The WHO recommends that: individuals with AUDIT scores between 8 and 15 receive simple advice in primary care to reduce hazardous drinking; individuals with scores 16-19 receive brief counseling and continued monitoring in primary care; and individuals with scores of 20 or greater receive specialty treatment (1). In HCC2, 5.1% of the sample (n=427) had an AUDIT score of 8 or greater, and thus by WHO criteria should receive an alcohol intervention. Most met criteria for intervention in primary care (N=344, or 4.4%, with scores 8-15, and N=44, or 0.5%, scores 16-19) and only 39 individuals (0.3%) had AUDIT scores indicating need for specialty treatment. Thus, among individuals requiring an alcohol intervention, only 1 in 20 (0.3%/5.1%) may initially require specialty treatment, by AUDIT criterion. The AUDIT manual does not discuss how comorbidity (mental health or drug use) affects the primary vs. specialty care treatment decision. One approach is that patients with comorbid mental health problems or drug abuse problems be seen in specialty care. In the HCC2 sample, 1.7% (N=172) had an AUDIT score of 8 or greater and a comorbid mental health disorder or problem drug use. Using this criterion, about one in three (1.7%/5.1%) individuals requiring an alcohol intervention may initially require specialty treatment. Thus, while services for alcohol use disorders are often narrowly viewed as specialty alcohol treatment, by WHO guidelines most individuals with hazardous drinking are appropriate candidates for primary care, at least initially, reserving specialty care for those with more severe alcohol problems, or hazardous drinking comorbid with mental health or drug abuse problems, or those who do not appear to benefit from brief interventions. However, despite the evidence base for primary care treatment of hazardous drinking (4, 5), there remain barriers to implementing primary care interventions, including absence of insurance reimbursement, lack of trained personnel, and the various demands currently placed on busy primary care practices. Finally, we would note that the validity of the AUDIT recommendations has not been well studied.

Percentage of Hazardous Drinkers Who Might Be Treated in Primary Care

Back to table of contents Previous article Next article LetterFull AccessLetterMark J. Edlund M.D., Ph.D.Brenda M. Booth Ph.D.Lingqi Tang Ph.D.Mark J. Edlund M.D., Ph.D.Search for more papers by this authorBrenda M. Booth Ph.D.Search for more papers by this authorLingqi Tang Ph.D.Search for more papers by this authorPublished Online:1 Nov 2010https://doi.org/10.1176/ps.2010.61.11.1163AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Percentage of Hazardous Drinkers Who Might Be Treated in Primary CareTo the Editor: Treatment of hazardous drinking can occur in the primary care or specialty alcohol treatment sector, depending on severity. Guidelines from the World Health Organization (WHO) ( 1 ) and the National Institute on Alcohol Abuse and Alcoholism ( 2 ) suggest that individuals with less severe disorders are appropriate candidates for primary care treatment with evidence-based interventions, including screening and brief interventions. We estimated the percentage of individuals with hazardous drinking who might be treated in primary care, using data from the second wave of the Healthcare for Communities survey (HCC2), conducted in 2000–2001 ( 3 ). HCC2 data are nationally representative, and the survey includes the AUDIT (Alcohol Use Disorders Identification Test) ( 1 ), developed by WHO to screen for hazardous drinking and to determine treatment setting. Estimates of the percentages of the population with hazardous drinking who can be treated in primary care and who require specialty care are vital for triage to the appropriate sector and allocation of scarce resources. Our analysis was based on 7,893 respondents and was weighted to be representative of the adult U.S. population. (Percentages reported are weighted, and counts are unweighted.) WHO recommends that individuals with AUDIT scores between 8 and 15 receive simple advice in primary care to reduce hazardous drinking, those with scores from 16 to 19 should receive brief counseling and continued monitoring in primary care, and those with scores of 20 or greater should receive specialty treatment ( 1 ). In HCC2, 5.1% of the sample (N=427) had an AUDIT score of 8 or greater, and thus by WHO criteria should receive an alcohol intervention. Most met criteria for intervention in primary care (344 respondents, or 4.4%, with scores of 8 to 15, and 44 respondents, or .5%, with scores of 16 to 19). Only 39 (.3%) had scores indicating a need for specialty treatment. Thus, among individuals requiring an alcohol intervention, only one in 20 (.3%/5.1%) may initially require specialty treatment, according to WHO criteria.The AUDIT manual does not discuss how comorbidity affects the treatment sector decision. One approach is to treat patients with comorbid disorders in specialty care. In the HCC2 sample, 1.7% (N=172) had an AUDIT score of 8 or greater and a comorbid mental disorder or problem drug use. Using this criterion, about one in three individuals (1.7%/5.1%) who require an intervention may initially require specialty treatment. Although services for alcohol use disorders are often narrowly viewed as specialty treatment, by WHO guidelines most individuals with hazardous drinking are appropriate for primary care, at least initially, reserving specialty care for those with more severe alcohol problems, those with comorbid mental health or drug use problems, and those who do not appear to benefit from brief interventions. However, despite the evidence base for primary care treatment of hazardous drinking ( 4 , 5 ), barriers to implementing such interventions remain, including absence of insurance reimbursement, lack of trained personnel, and multiple demands placed on busy primary care practices. Sustained translational efforts are needed to overcome these barriers. Finally, we should note that the validity of the AUDIT recommendations has not been well studied. Acknowledgments and disclosuresThe study was funded by grant R01AA16299 from the National Institute on Alcohol Abuse and Alcoholism.The authors report no competing interests.Dr. Edlund and Dr. Booth are affiliated with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Dr. Booth is also with the Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, North Little Rock. Dr. Tang is with the Health Services Research Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.

An Intervention for Treating Alcohol Dependence: Relating Elements of Medical Management to Patient Outcomes With Implications for Primary Care

Alcohol dependence, frequently seen in medical settings, is a major problem that affects the health and well-being of many individuals and their families. The purpose of this study was to examine the relationship between treatment outcomes and patient and clinician factors specifically associated with a medically oriented intervention given for the treatment of alcohol dependence. The intervention was developed for the National Institute on Alcohol Abuse and Alcoholism-sponsored COMBINE Study, a randomized controlled trial combining 2 medications, naltrexone and acamprosate, with Medical Management, with or without specialty alcohol treatment. We examined the effect of patient adherence to treatment (number of Medical Management visits, total minutes in treatment, alliance or therapeutic relationship with the clinician, patient satisfaction with treatment, and clinician adherence to the Medical Management protocol) on abstinence from alcohol, amount of heavy drinking, and clinical improvement during treatment. More Medical Management visits attended and less total time spent in Medical Management treatment was associated with more days of abstinence from alcohol, reductions in heavy alcohol drinking, and a higher likelihood of clinical improvement. The patients' positive perceptions of their alliance with their clinician and their satisfaction with treatment was significantly associated with more days of abstinence from alcohol during treatment. Two clinician factors clinician confidence in the Medical Management treatment and flexibility in delivering Medical Management were also associated with better patient outcomes. Medically trained clinicians with minimal specialty training in alcohol dependence treatments were able to deliver a brief and effective medication management intervention that was designed to be consistent with primary care practice.

Alcohol Use Disorders and the Use of Treatment Services Among College-Age Young Adults

Alcohol Use Disorders and the Use of Treatment Services Among College-Age Young Adults

Drinking in the Year After Treatment as a Predictor of Three-Year Drinking Outcomes

Previous research suggests that abstinence from alcohol during the first year posttreatment for alcohol-use disorders (AUDs) is an important, independent predictor of longer-term alcohol consumption and related functioning. The purpose of this study was to test the hypothesis that abstinence during the first year posttreatment initiation predicts alcohol use at Months 37-39. A second aim of this study was to explore the relationship between "moderate" drinking in the first year and drinking at Months 37-39. Secondary data analyses were conducted on the outpatient Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) sample (N = 952 at baseline and 802 at Months 37-39). For these analyses, participants were classified first as abstainers, moderate drinkers, or heavy drinkers based on their alcohol use in the first year posttreatment initiation. Analyses of covariance showed that the first-year drinker classification predicted both percentage of days abstinent and drinks per drinking day at Months 37-39. Subsequent analyses showed that the abstainers functioned significantly better than (1) both of the other drinker groups combined and (2) either of the other two groups, which did not differ from each other on either measure of alcohol use. A third set of exploratory analyses evaluated first-year abstinence and heavy drinking as continuous variables and showed an essentially linear relationship between them and drinking at 3 years. This study confirmed the strong relationship between first-year abstinence and later drinking but did not show that participants who engaged in moderate drinking during the first year had positive alcohol-use outcomes at 3 years. The clinical implications of the findings, their generalizability to different populations of individuals presenting for specialty alcohol treatment, and future research directions are discussed.