Treatment outcome of alcohol use disorder outpatients with or without medically assisted detoxification.

OBJECTIVE: Little is known about the incremental effects of medically assisted detoxification on outpatient treatment for alcohol use disorders. The objective of this study was to compare drinking outcomes in a psychosocial treatment program between two groups of heavy drinking patients who had an alcohol use disorder: (a) one group with initial medically assisted detoxification and (b) a second group without initial medically assisted detoxification. METHOD: Analyses were conducted on 262 patients with a more severe alcohol use disorder who completed both an intake assessment and a 9-month follow-up assessment. The effect of medically assisted detoxification was determined using logistic regression analysis with a propensity score to control for possible baseline differences between the two groups. RESULTS: Of the 262 patients, 82 (31.3%) received medically assisted detoxification. These patients were more likely to abstain from alcohol than those without medically assisted detoxification. Abstinence rates in the month before follow-up were 32.9% and 18.9%, respectively (ORadj = 3.48, p = .01, number needed to treat = 7.1). CONCLUSIONS: Medically assisted detoxification may add to the effects of outpatient psychosocial treatment for heavy drinking patients with an alcohol use disorder.

Investigating the structure of craving using structural equation modeling in analysis of the obsessive-compulsive drinking scale: a multinational study.

BACKGROUND: Currently, there is no agreement among researchers on the definition of craving and its underlying theoretical model. The Obsessive-Compulsive Drinking Scale (OCDS) seems to measure certain aspects of craving, but its theoretical basis remains unclear. The aim of this study was to investigate the structure of alcohol craving, using OCDS data. METHODS: OCDS data from four studies were pooled to obtain a large and heterogeneous sample of 505 participants. All participants were treatment-seeking alcoholics meeting DSM-IV criteria for alcohol dependence. The factor structures of the OCDS previously found were evaluated using confirmatory factor analyses. The goodness of fit of these solutions was compared with those of alternative causal models: an obsessive-compulsive disorder model, an inhibition model, and a cognitive-behavioral model. These alternative models were based on modern theories about craving and were tested in the OCDS data, using structural equation modeling. In this way, the current study replaced simple correlational analysis by a more sophisticated causal way of analyzing the underlying structure of the OCDS items. The best fitting model was selected by comparing the mean discrepancy between the implied and observed matrices of the models. RESULTS: The data showed that the previously reported factor structures had to be rejected. Also, the inhibition model and obsessive-compulsive disorder model did not fit the data. The cognitive-behavioral model showed encouraging fit. Optimizing strategies were applied to further improve the fit of this model, which resulted in a model with close fit to the data. CONCLUSIONS: The causal cognitive-behavioral model proved to be superior. It showed that the OCDS contains many items that do not represent the core concept of craving but instead are indicators for the consequences of craving. From this model, it seems that craving, in a narrow sense, can be reliably assessed with only five items of the OCDS.