Is Specialized Integrated Treatment for Comorbid Anxiety, Depression and Alcohol Dependence Better than Treatment as Usual in a Public Hospital Setting?

AIM: To assess the effectiveness of a 12 week specialized, integrated intervention for alcohol dependence with comorbid anxiety and/or mood disorder using a randomized design in an outpatient hospital setting. METHODS: Out of 86 patients meeting the inclusion criteria for alcohol dependence with suspicion of comorbid anxiety and/or depressive disorder, 57 completed a 3-week stabilization period (abstinence or significantly reduced consumption). Of these patients, 37 (65%) met a formal diagnostic assessment of an anxiety and/or depressive disorder and were randomized to either (a) integrated intervention (cognitive behavioural therapy) for alcohol, anxiety and/or depression, or (b) usual counselling care for alcohol problems. RESULTS: Intention-to-treat analyses revealed a beneficial treatment effect of integrated treatment relative to usual counselling care for the number of days to relapse (χ(2) = 6.42, P < 0.05) and lapse (χ(2) = 10.73, P < 0.01). In addition, there was a significant interaction effect of treatment and time for percentage days of abstinence (P < 0.05). For heavy drinking days, the treatment effect was mediated by changes in DASS anxiety (P < 0.05). There were no significant treatment interaction effects for DASS depression or anxiety symptoms. CONCLUSIONS: These results provide support for integrated care in improving drinking outcomes for patients with alcohol dependence and comorbid depression/anxiety disorder. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01941693.

An evaluation of Cloninger's typology of alcohol abuse.

AIMS: To evaluate Cloninger's typology of "alcoholism" using the Alcohol Symptom Scale (Gilligan et al., 1987). PARTICIPANTS: A sample of 300 Australian men and women with a life-time diagnosis of DSM-III-R alcohol abuse/dependence. MEASURES: The Alcohol Dependence Scale, the Short Alcoholism Screening Test, the Composite International Diagnostic Interview (CIDI) Substance Abuse Module, the Brief Symptom Inventory, the CIDI core modules, the Family History Questionnaire and the Sensation Seeking Scale. FINDINGS: The Alcohol Symptom Scale classified only 18% of the sample into either type 1 or type 2. There was mixed support for the hypothesized differences between type 1 and type 2 problem drinkers in pattern of alcohol abuse, gender, personality characteristics and familial aggregation of alcohol abuse. More women than men were classified as type 1 (19% vs. 6%) but, contrary to expectations, similar numbers were classified as type 2 problem drinkers (7% vs. 4%). As predicted, type 2 problem drinkers had more symptoms of antisocial personality disorder, more social consequences of drinking and higher sensation-seeking scores than type 1 problem drinkers. CONCLUSIONS: Cloninger's typology failed to classify two types of problem drinkers and it did not predict gender differences in symptoms of alcohol dependence, family history or personality. Schuckit, Irwin & Mahler's (1990) hypothesis that type 2 problem drinkers are more likely to have primary ASPD was supported.

A prospective study of treatment outcome with a group of male problem drinkers.

The present study was a follow-up of a group of young male problem drinkers (N = 96) presenting to a community-based treatment facility. Clients were assessed before and a minimum of twelve months after a set of brief treatment programs using a number of drinking- and nondrinking-related measures of functioning and corroborative information from a collateral. Regular contact was maintained with clients and collaterals throughout the follow-up period. Follow-up assessment data were available for 80 (83.3%) clients and collateral information for 84 (88%) clients. There were no significant differences found at follow-up between treatments used. There were, however, significant improvements evident on all measures of functioning in the total client group. Using stepwise discriminant analyses, clients classified as problem drinkers at follow-up were found to have higher scores on indices of problem drinking (including alcohol consumption, blackouts and legal charges) at their pretreatment assessment. Multiple regression analyses revealed that the best pretreatment predictors of client functioning at follow-up were measures of alcohol-related problems (accidents, jail, hangovers, morning drinking and deterioration). Factors limiting the interpretability and generalizability of these findings are discussed with particular reference to sample size and idiosyncrasies.

Aftercare attendance and post-treatment functioning of severely substance dependent residential treatment clients.

The present study evaluated the impact of a structured aftercare programme following residential treatment for severe alcohol and/or heroin dependent clients. Over 17 months, 77 participants were recruited to the study and allocated randomly to either a structured aftercare (SA) programme or to unstructured aftercare (UA) of crisis counselling on request. Independent clinicians interviewed participants and collaterals, at 4-month (median) intervals, for 12 months following residential treatment. SA compared to UA was associated with a fourfold increase in aftercare attendance and one-third the rate of uncontrolled principal substance use at follow-up. Participants who attended either type of aftercare relapsed a median of 134 days later than those who attended no aftercare. Overall, 23% of monitored participants remained abstinent throughout, 21% maintained controlled substance use and 56% relapsed, within a median of 36 days following residential treatment. The only significant predictor of days to relapse, controlling for age, was pretreatment use of additional substances. Participants with pretreatment additional substance use relapsed a median of 192 days earlier than those who had used no other substances. The degree of agreement between participant self-reports and collateral reports was fair-to-moderate and moderate among collaterals. Intention-to-treat analyses revealed significant and clinically meaningful reductions in substance use in this sample of severely dependent residential treatment clients. The generalizability of these results is limited because of significant differences in age and presenting substance between the study sample and other clients admitted to the service during the study. This latter group of younger, male, heroin-dependent clients with polydrug use who refuse opioid pharmacotherapy, are more likely to drop out of treatment or relapse early following treatment and continue to present a challenge to treatment services.