Changes of Self-reported PTSD and Depression Symptoms During Alcohol Detoxification Treatment.

Objective: There is a lack of empirical knowledge on how different comorbid disorders and symptoms change in the course of initial abstinence and withdrawal. The aim of this study is to replicate previous findings on the symptom course using a larger sample and up-to-date psychometric instruments. Methods: During inpatient alcohol detoxification, we measured comorbid depression (Beck Depression Inventory second revision; BDI-II) and posttraumatic stress disorder (PTSD Checklist for DSM-5; PCL-5) symptoms twice among 87 participants within a 10-day interval. Results: Significant decreases occurred for symptoms of reexperiencing (p < .001, d = .27), avoidance (p < .001, d = .41), negative cognitions (p = .03, d = .22), alteration in arousal (p < .001, d = .37), and the PCL-5 total score (p < .001, d = .35). Depression scores also significantly declined with a greater effect size (p < .001, d = .53). Depression screening was not stable, while posttraumatic stress disorder screening was revealed to be stable through alcohol detoxification. Interaction effects were detected, indicating the higher symptom decrease for patients who initially had positive posttraumatic stress disorder and depression screenings, F(1, 84) = 23.01, p < .001 and F(1, 84) = 10.01, p < .01, respectively. Conclusions: Patients in the first stage of alcohol treatment show high levels of comorbid psychopathology. These symptoms change during detoxification, especially for patients having a higher initial symptomatic burden. More research is needed to guide practitioners to make reliable comorbid diagnoses in this early treatment phase as this can motivate patients to pursue subsequent treatments.

Integrated Treatment at the First Stage: Increasing Motivation for Alcohol Patients with Comorbid Disorders during Inpatient Detoxification.

AIMS: Co-occurring mental disorders can complicate the detoxification treatment process and outcome. The aim of this study is to examine whether a brief psychoeducational group counseling session during detoxification treatment can increase the motivation for and utilization of subsequent treatments. SHORT SUMMARY: Interventions increased utilization of post-detoxification treatment and reduced alcohol-related readmissions. Higher depression or trauma scores were associated with higher rates of utilization of treatment. METHODS: Patients received either a brief manualised group intervention on the interrelation of alcohol use disorder (AUD) and major depression (MD) or AUD and post-traumatic stress disorder (PTSD) or a cognitive training session (control group). Of the 784 patients treated in the study period, 171 participants were quasi-randomly allocated to groups. Self-reported motivation was measured before and after intervention, transition into AUD treatment and readmissions were collected after detoxification treatment. RESULTS: Participating in any of the intervention groups increased the utilization of AUD treatment after inpatient detoxification (χ2 = 6.15, P = 0.02) and decreased readmissions 6 months after discharge (χ2 = 7.46, P = 0.01). Depression and trauma scores moderated the effect: associations with the utilization of post-detoxification treatment were found in participants with higher depression (OR = 5.84, 95% CI = 1.17-29.04) or trauma scores (OR = 10.17, 95% CI = 1.54-67.1). CONCLUSIONS: An integrated intervention approach for dual diagnosis at the beginning of the treatment can increase motivation for continued AUD treatment. Especially affected dual diagnosis patients can benefit from this treatment.

Web-Based Alcohol Intervention: Study of Systematic Attrition of Heavy Drinkers.

BACKGROUND: Web-based alcohol interventions are a promising way to reduce alcohol consumption because of their anonymity and the possibility of reaching a high numbers of individuals including heavy drinkers. However, Web-based interventions are often characterized by high rates of attrition. To date, very few studies have investigated whether individuals with higher alcohol consumption show higher attrition rates in Web-based alcohol interventions as compared with individuals with lower alcohol consumption. OBJECTIVES: The aim of this study was to examine the attrition rate and predictors of attrition in a Web-based intervention study on alcohol consumption. METHODS: The analysis of the predictors of attrition rate was performed on data collected in a Web-based randomized control trial. Data collection took place at the University of Konstanz, Germany. A total of 898 people, which consisted of 46.8% males (420/898) and 53.2% females (478/898) with a mean age of 23.57 years (SD 5.19), initially volunteered to participate in a Web-based intervention study to reduce alcohol consumption. Out of the sample, 86.9% (781/898) were students. Participants were classified as non-completers (439/898, 48.9%) if they did not complete the Web-based intervention. Potential predictors of attrition were self-reported: alcohol consumption in the last seven days, per week, from Monday to Thursday, on weekends, excessive drinking behavior measured with the Alcohol Use Disorder Identification Test (AUDIT), and drinking motives measured by the Drinking Motive Questionnaire (DMQ-R SF). RESULTS: Significant differences between completers and non-completers emerged regarding alcohol consumption in the last seven days (B=-.02, P=.05, 95% CI [0.97-1.00]), on weekends (B=-.05, P=.003, 95% CI [0.92-0.98]), the AUDIT (B=-.06, P=.007, 95% CI [0.90-0.98], and the status as a student (B=.72, P=.001, 95% CI [1.35-3.11]). Most importantly, non-completers had a significantly higher alcohol consumption compared with completers. CONCLUSIONS: Hazardous alcohol consumption appears to be a key factor of the dropout rate in a Web-based alcohol intervention study. Thus, it is important to develop strategies to keep participants who are at high risk in Web-based interventions.