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1.
J Subst Abuse Treat ; 144: 108920, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36334384

RESUMO

INTRODUCTION: We know very little about how the pandemic impacted outpatient alcohol use disorder (AUD) care and the role of telemedicine. METHODS: Using OptumLabs® Data Warehouse de-identified administrative claims, we identified AUD cohorts in 2018 (N = 23,204) and 2019 (N = 23,445) and examined outpatient visits the following year, focusing on week 12, corresponding to the March 2020 US COVID-19 emergency declaration, through week 52. Using multivariable logistic regression, we examined the association between patient demographic and clinical characteristics and receipt of any outpatient AUD visits in 2020 vs. 2019. RESULTS: In 2020, weekly AUD visit utilization decreased maximally at the pandemic start (week 12) by 22.5 % (2019: 3.8 %, 2020: 3.0 %, percentage point change [95 % CI] = -0.86[-1.19, -0.05]) but was similar to 2019 utilization by mid-April 2020 (week 16). Telemedicine accounted for 50.1 % of AUD visits by early July 2020 (week 27). Individual therapy returned to 2019 levels within 1 week (i.e., week 13) whereas group therapy did not consistently do so until mid-August 2020 (week 31). Further, individual therapy exceeded 2019 levels by as much as 50 % starting mid-October 2020. The study found no substantial differences in visits by patient demographic or clinical characteristics. CONCLUSIONS: Among patients with known AUD, initial outpatient care disruptions were relatively brief. However, substantial shifts occurred in care delivery-an embrace of telemedicine but also more pronounced, longer disruptions in group therapy vs. individual and an increase in individual therapy use. Further research needs to help us understand the implications of these findings for clinical outcomes.


Assuntos
Alcoolismo , COVID-19 , Telemedicina , Adulto , Estados Unidos , Humanos , Pandemias , Alcoolismo/epidemiologia , Alcoolismo/terapia , Estudos de Coortes
2.
Addiction ; 118(1): 71-85, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35971295

RESUMO

BACKGROUND AND AIMS: Alcohol use disorder (AUD) is a chronic disorder with high relapse rates. There are currently few clinical trials of high frequency repetitive transcranial magnetic stimulation (HF-rTMS) to reduce alcohol use among AUD patients, and results are mixed. The current study tested the effect of 10 add-on sessions of HF-rTMS over the right dorsolateral pre-frontal cortex (DLPFC) on alcohol use and craving. DESIGN: Single-center, single blind sham-controlled parallel-group RCT (n = 80), with 3 and 6 months follow-up. SETTING: Clinical treatment center in Amsterdam, the Netherlands. PARTICIPANTS: Eighty detoxified and abstinent AUD inpatients in clinical treatment (20 females, average age = 44.35 years). INTERVENTION: Ten sessions of active or sham HF-rTMS (60 10 Hz trains of 5 sec at 110% motor threshold) over the right DLPFC on 10 consecutive work-days. MEASUREMENTS: The primary outcome measure is the number of abstinent days over 6-month follow-up (FU). Secondary outcome measures are craving over 6-month FU (alcohol urge questionnaire and obsessive-compulsive drinking scale), time to first relapse over 6-month FU and grams of alcohol consumed over 6-month FU. Additional outcome measures: full abstinence over 6-month FU and treatment success over 12-month FU. FINDINGS: HF-rTMS did not affect the number of abstinent days over 6 months FU [sham = 124 ± 65.9 days, active = 115 ± 69.8 days, difference: 9 days, 95% confidence interval (CI) = Poisson model: 0.578-3.547]. Moreover, HF-rTMS did not affect craving (AUQ/OCDS) (sham = 15.38/5.28, active = 17.48/4.75, differences = 2.1/-0.53, 95% CI mixed-effects model = -9.14 to 2.07/-1.44 to 2.40). CONCLUSIONS: There was no clear evidence that high-frequency repetitive transcranial magnetic stimulation over the right dorsolateral pre-frontal cortex treatment has a long-term positive effect on alcohol use or craving as add-on treatment for alcohol use disorder. High treatment response at 6-month follow-up could have limited the possibility to find an effect.


Assuntos
Alcoolismo , Estimulação Magnética Transcraniana , Feminino , Humanos , Adulto , Estimulação Magnética Transcraniana/métodos , Fissura/fisiologia , Alcoolismo/terapia , Método Simples-Cego , Pacientes Internados , Córtex Pré-Frontal/fisiologia , Resultado do Tratamento , Recidiva
3.
Clin Liver Dis ; 27(1): 157-172, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36400463

RESUMO

The prevalence of alcohol consumption, alcohol use disorder (AUD), and alcohol-related liver disease (ALD) has exponentially increased over the last several years and rates continue to increase. Significant alcohol use can cause progression from steatosis in the liver to inflammation, fibrosis, and eventually cirrhosis. Additional risk factors for the progression of ALD disease include gender, race, and genetic predisposition. As such, it is essential for clinicians to understand and implement screening tools for early diagnosis of both AUD and ALD and be aware of emerging novel treatment options.


Assuntos
Alcoolismo , Hepatopatias Alcoólicas , Transplante de Fígado , Humanos , Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/epidemiologia , Hepatopatias Alcoólicas/etiologia , Alcoolismo/complicações , Alcoolismo/terapia , Consumo de Bebidas Alcoólicas/efeitos adversos , Transplante de Fígado/efeitos adversos
5.
Addict Sci Clin Pract ; 17(1): 62, 2022 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-36348370

RESUMO

BACKGROUND: Alcohol use disorder (AUD) and anxiety disorders (AnxD) are prevalent health concerns in clinical practice which frequently co-occur (AUD-AnxD) and compound one another. Concurrent AUD-AnxD poses a challenge for clinical management as approaches to treatment of one disorder may be ineffective or potentially counterproductive for the other disorder. CASE PRESENTATION: We present the case of a middle-aged man with anxiety disorder, AUD, chronic pain, and gamma-hydroxybutyrate use in context of tapering prescribed benzodiazepines who experienced severe alcohol withdrawal episodes during a complicated course of repeated inpatient withdrawal management. After medical stabilization, the patient found significant improvement in symptoms and no return to alcohol use with a regimen of naltrexone targeting his AUD, gabapentin targeting both his AUD and AnxD, and engagement with integrated psychotherapy, Alcoholics Anonymous, and addictions medicine follow-up. CONCLUSION: Proper recognition and interventions for AUD and AnxD, ideally with overlapping efficacy, can benefit individuals with comorbid AUD-AnxD. Gabapentin, tobacco cessation, and integrated psychotherapy have preliminary evidence of synergistic effects in AUD-AnxD. Meta-analysis evidence does not support serotoninergic medications (e.g. selective serotonin reuptake inhibitors) which are commonly prescribed in AnxD and mood disorders as their use has not been associated with improved outcomes for AUD-AnxD. Additionally, several double-blind placebo-controlled randomized trials have suggested that serotonergic medications may worsen alcohol-related outcomes in some individuals with AUD. Areas for future investigation are highlighted.


Assuntos
Alcoolismo , Síndrome de Abstinência a Substâncias , Pessoa de Meia-Idade , Masculino , Humanos , Alcoolismo/complicações , Alcoolismo/epidemiologia , Alcoolismo/terapia , Gabapentina/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/epidemiologia , Ansiedade , Comorbidade , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Artigo em Inglês | MEDLINE | ID: mdl-36429926

RESUMO

People experiencing homelessness and alcohol dependence are at increased risk of a range of harms, including from COVID-19. Managed Alcohol Programmes (MAPs) are an alcohol harm reduction intervention specifically for this group. In this paper we report on qualitative findings of a mixed methods study investigating the potential utility of MAPs during the COVID-19 pandemic in Scotland. Interviews, conducted with 40 participants, explored potential views of implementing MAPs during the pandemic. Theoretically, we drew on the Consolidated Framework for Implementation Research (CFIR) to inform data collection and analysis. Six themes were identified which mapped onto three CFIR domains: perceptions of MAPs and the evidence base; necessary components of MAPs; changing culture of alcohol harm reduction; MAPs as a moral and ethical grey area; addressing a service gap; and securing buy-in and partnership working. Participants were generally positive about MAPs and viewed them as a key intervention to address a service gap. Several necessary components were identified for successful implementation of MAPs. Securing buy-in from a range of stakeholders and partnership working were deemed important. Finally, MAPs require careful, long-term planning before implementation. We conclude that MAPs are needed in Scotland and require long-term funding and appropriate resources to ensure they are successful.


Assuntos
Alcoolismo , COVID-19 , Humanos , COVID-19/epidemiologia , Pandemias/prevenção & controle , Etanol , Alcoolismo/epidemiologia , Alcoolismo/terapia , Escócia/epidemiologia
8.
PLoS One ; 17(11): e0276111, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36445895

RESUMO

OBJECTIVE: To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD. METHOD: Participants with current PTSD/AUD (N = 101; mean age = 42.10; 56% female) were initially randomized to CPT, RP, or AO and assessed post-treatment or 6-weeks post-randomization (AO). AO participants were then re-randomized to CPT or RP. Follow-ups were at immediate post-treatment, 3-, and 12-months. Mixed effects intent-to-treat models compared conditions on changes in PTSD symptom severity, drinking days, and heavy drinking days. RESULTS: At post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity (b = -9.72, 95% CI [-16.20, -3.23], d = 1.22); the RP and AO groups did not differ significantly on PTSD. Both active treatment conditions significantly decreased heavy drinking days relative to AO (CPT vs. AO: Count Ratio [CR] = 0.51, 95% CI [0.30, 0.88]; RP vs. AO: CR = 0.34, 95% CI [0.19, 0.59]). After re-randomization both treatment conditions showed substantial improvements in PTSD symptoms and drinking between pre-treatment and post-treatment over the 12-month follow-up period, with RP showing an advantage on heavy drinking days. CONCLUSION: Treatments targeting one or the other aspects of the PTSD/AUD comorbidity may have salutary effects on both PTSD and drinking outcomes. These preliminary results suggest that people with this comorbidity may have viable treatment options whether they present for mental health or addiction care. TRIAL REGISTRATION: The trial is registered at clinicaltrials.gov (NCT01663337).


Assuntos
Alcoolismo , Terapia Cognitivo-Comportamental , Transtornos de Estresse Pós-Traumáticos , Feminino , Humanos , Adulto , Masculino , Alcoolismo/complicações , Alcoolismo/epidemiologia , Alcoolismo/terapia , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Prevenção Secundária , Comorbidade
9.
BMJ Open ; 12(11): e064578, 2022 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-36410826

RESUMO

INTRODUCTION: Prior to the COVID-19 pandemic, substance use health services for treatment of alcohol use disorder and problematic alcohol use (AUD/PAU) were fragmented and challenging to access. The pandemic magnified system weaknesses, often resulting in disruptions of treatment as alcohol use during the pandemic rose. When treatment services were available, utilisation was often low for various reasons. Virtual care was implemented to offset the drop in in-person care, however accessibility was not universal. Identification of the characteristics of treatment services for AUD/PAU that impact accessibility, as perceived by the individuals accessing or providing the services, will provide insights to enable improved access. We will perform a scoping review that will identify characteristics of services for treatment of AUD/PAU that have been identified as barriers to or facilitators of service access from the perspectives of these groups. METHODS AND ANALYSIS: We will follow scoping review methodological guidance from the Joanna Briggs Institute. Using the OVID platform, we will search Ovid MEDLINE including Epub Ahead of Print and In-Process and Other Non-Indexed Citations, Embase Classic+Embase, APA PsychInfo, Cochrane Register of Controlled Trials, the Cochrane Database of Systematic Reviews and CINAHL (Ebsco Platform). Multiple reviewers will screen citations. We will seek studies reporting data collected from individuals with AUD/PAU or providers of treatment for AUD/PAU on service-level factors affecting access to care. We will map barriers to and facilitators of access to AUD/PAU treatment services identified in the relevant studies, stratified by service type and key measures of inequity across service users. ETHICS AND DISSEMINATION: This research will enhance awareness of existing evidence regarding barriers to and facilitators of access to services for the treatment of alcohol use disorder and problematic alcohol use. Findings will be disseminated through publications, conference presentations and a stakeholder meeting. As this is a scoping review of published literature, no ethics approval was required.


Assuntos
Alcoolismo , COVID-19 , Humanos , Alcoolismo/terapia , Pandemias , COVID-19/terapia , Revisões Sistemáticas como Assunto , Serviços de Saúde , Literatura de Revisão como Assunto
10.
Neuropsychobiology ; 81(5): 387-402, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36404705

RESUMO

INTRODUCTION: Positively conditioned Pavlovian cues tend to promote approach and negative cues promote withdrawal in a Pavlovian-to-instrumental transfer (PIT) paradigm, and the strength of this PIT effect was associated with the subsequent relapse risk in alcohol-dependent (AD) patients. When investigating the effect of alcohol-related background cues, instrumental approach behavior was inhibited in subsequent abstainers but not relapsers. An automatic approach bias towards alcohol can be modified using a cognitive bias modification (CBM) intervention, which has previously been shown to reduce the relapse risk in AD patients. Here we examined the effects of such CBM training on PIT effects and explored its effect on the relapse risk in detoxified AD patients. METHODS: N = 81 recently detoxified AD patients performed non-drug-related and drug-related PIT tasks before and after CBM versus placebo training. In addition, an alcohol approach/avoidance task (aAAT) was performed before and after the training to assess the alcohol approach bias. Patients were followed up for 6 months. RESULTS: A stronger alcohol approach bias as well as a stronger non-drug-related PIT effect predicted relapse status in AD patients. No significant difference regarding relapse status or the number of heavy drinking days was found when comparing the CBM training group versus the placebo group. Moreover, there was no significant modulation effect of CBM training on any PIT effect or the aAAT. CONCLUSION: A higher alcohol approach bias in the aAAT and a stronger non-drug-related PIT effect both predicted relapse in AD patients, while treatment outcome was not associated with the drug-related PIT effect. Unlike expected, CBM training did not significantly interact with the non-drug-related or the drug-related PIT effects or the alcohol approach bias.


Assuntos
Alcoolismo , Transtornos Cognitivos , Humanos , Alcoolismo/terapia , Etanol , Comportamento de Escolha , Cognição
11.
Bratisl Lek Listy ; 123(11): 785-790, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36254635

RESUMO

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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).


Assuntos
Alcoolismo , Alcoolismo/terapia , Etanol , Humanos , Pacientes Ambulatoriais
12.
BMC Public Health ; 22(1): 1967, 2022 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-36289538

RESUMO

BACKGROUND: This study examined the prevalence of screening and brief intervention (SBI) for alcohol use disorder (AUD) risk in samples of adult drinkers in three middle-income countries (Brazil, China, South Africa), and the extent to which meeting criteria for AUD risk was associated with SBI. METHODS: Cross-sectional survey data were collected from adult samples in two cities in each country in 2018. Survey measures included past-year alcohol use, the CAGE assessment for AUD risk, talking to a health care professional in the past year, alcohol use screening by a health care professional, receiving advice about drinking from a health care professional, and sociodemographic characteristics. The prevalence of SBI was determined for past-year drinkers in each country and for drinkers who had talked to a health care professional. Logistic regression analyses were conducted to examine whether meeting criteria for AUD risk was associated with SBI when adjusting for sociodemographic characteristics. RESULTS: Among drinkers at risk for AUD, alcohol use screening rates ranged from 6.7% in South Africa to 14.3% in Brazil, and brief intervention rates ranged from 4.6% in South Africa to 8.2% in China. SBI rates were higher among drinkers who talked to a health care professional in the past year. In regression analyses, AUD risk was positively associated with SBI in China and South Africa, and with brief intervention in Brazil. CONCLUSION: Although the prevalence of SBI among drinkers at risk for AUD in Brazil, China, and South Africa appears to be low, it is encouraging that these drinkers were more likely to receive SBI.


Assuntos
Alcoolismo , Adulto , Humanos , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Alcoolismo/terapia , Intervenção na Crise , Estudos Transversais , Países em Desenvolvimento , Consumo de Bebidas Alcoólicas/epidemiologia , Programas de Rastreamento
13.
Ann Intern Med ; 175(10): ITC145-ITC160, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36215713

RESUMO

Unhealthy alcohol use-the consumption of alcohol at a level that has caused or has the potential to cause adverse physical, psychological, or social consequences-is common, underrecognized, and undertreated. For example, data from the 2020 National Survey on Drug Use and Health indicate that 7.0% of adults reported heavy alcohol use in the previous month, and only 4.2% of adults with alcohol use disorder received treatment. Primary care is an important setting for optimizing screening and treatment of unhealthy alcohol use to promote individual and public health.


Assuntos
Consumo de Bebidas Alcoólicas , Alcoolismo , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/complicações , Alcoolismo/epidemiologia , Alcoolismo/terapia , Etanol , Humanos , Programas de Rastreamento
14.
Nat Commun ; 13(1): 6198, 2022 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-36261423

RESUMO

Alcohol use disorder is a major cause of morbidity, which requires newer treatment approaches. We previously showed in a randomized clinical trial that alcohol craving and consumption reduces after fecal transplantation. Here, to determine if this could be transmitted through microbial transfer, germ-free male C57BL/6 mice received stool or sterile supernatants collected from the trial participants pre-/post-fecal transplant. We found that mice colonized with post-fecal transplant stool but not supernatants reduced ethanol acceptance, intake and preference versus pre-fecal transplant colonized mice. Microbial taxa that were higher in post-fecal transplant humans were also associated with lower murine alcohol intake and preference. A majority of the differentially expressed genes (immune response, inflammation, oxidative stress response, and epithelial cell proliferation) occurred in the intestine rather than the liver and prefrontal cortex. These findings suggest a potential for therapeutically targeting gut microbiota and the microbial-intestinal interface to alter gut-liver-brain axis and reduce alcohol consumption in humans.


Assuntos
Alcoolismo , Transplante de Microbiota Fecal , Humanos , Camundongos , Animais , Masculino , Alcoolismo/terapia , Camundongos Endogâmicos C57BL , Consumo de Bebidas Alcoólicas , Etanol
15.
Subst Abuse Treat Prev Policy ; 17(1): 69, 2022 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-36303216

RESUMO

BACKGROUND: According to a landmark decision by the Swiss Federal Supreme Court, people with a substance use disorder (SUD) are now eligible for disability benefits if their disorder impairs their ability to work. Alcohol use disorder (AUD) is one of the most common SUDs in Switzerland and is associated with high societal and economic costs. This study aimed to gain an in-depth understanding of the views of professional stakeholder groups regarding AUD and their opinions on the new legal precedent. METHODS: Swiss social insurance lawyers, insurance medical experts, and addiction-specialist therapists (N = 79) answered an online questionnaire. Due to violations of the assumption of normality, non-parametric tests are reported in most cases. RESULTS: Therapists held significantly higher regard for patients with AUD than both lawyers and insurance medical experts. All three groups strongly supported a disease view of AUD but agreed significantly less that it was a disease like cancer, suggesting that AUDs might be seen as at least partially self-inflicted. Overall, moralist views of AUD received considerably less support than the disease view, with lawyers agreeing with moralist views more than therapists. All groups were well-informed and largely supportive about the new legal precedent. When asked about stipulating participation in medical treatment to mitigate damages associated with a claim, attending therapy was supported the most amongst the groups (80% of participants felt this was somewhat or fully appropriate), followed by a reduction in drinking quantity (58%), and abstinence (18%). In all three groups, we identified associations between certain views and opinions on AUD and support for the new legal precedent. CONCLUSIONS: Whilst there were differences between the stakeholder groups in their regard for and views of AUD, all three adopted a clear harm-reduction approach with respect to measures to mitigate damages associated with the insurance disability claim. A possible connection of this stance with the Swiss national drug policy in recent years is discussed together with limitations of the study and practical implications of the findings.


Assuntos
Alcoolismo , Seguro por Invalidez , Humanos , Alcoolismo/terapia , Suíça , Advogados , Consumo de Bebidas Alcoólicas
16.
Int J Drug Policy ; 109: 103862, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36206611

RESUMO

Alcohol use is a major source of morbidity and mortality globally. Numerous adverse health outcomes have been linked to alcohol use, including liver disease, road injuries, violence, cancer, cardiovascular disease, suicide, domestic violence and family breakdown. Alcohol use is responsible for approximately three million deaths per year across the globe. Different paradigms have been employed in the treatment of alcohol use disorder, including abstinence-based and harm-reduction models. Radical acceptance, which has been successfully applied elsewhere in mental health treatment, has not gained purchase in the treatment of addictions. We used a set of corpus linguistics techniques to analyze a dataset of approximately 10,000 posts in an online forum for self-identified severe alcoholics. The forum we studied explicitly claims a radical acceptance approach to alcohol use disorder. The forum is "for people who accept their lifestyle choice and don't want to be interrupted . . ." We combined quantitative methods (keyword and collocation analysis) and qualitative methods (concordancing) to conduct a discourse analysis of the linguistic and rhetorical practices employed in the forum. We found that although the forum purports to embrace acceptance and eschew change, in fact, the discursive practices in the forum reveal a highly ambivalent relation with both acceptance and change. We found that acceptance and change are in dialectical tension that mirrors the structure agency dialectic described in critical realism. We suggest there may be merit in considering employing a radical acceptance paradigm in addictions treatment.


Assuntos
Alcoolismo , Suicídio , Humanos , Alcoolismo/terapia , Idioma , Consumo de Bebidas Alcoólicas
18.
Drug Alcohol Depend ; 239: 109607, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36084444

RESUMO

BACKGROUND: The combination of unhealthy alcohol use and depression is associated with adverse outcomes including higher rates of alcohol use disorder and poorer depression course. Therefore, addressing alcohol use among individuals with depression may have a substantial public health impact. We compared the effectiveness of a brief intervention (BI) for unhealthy alcohol use among patients with and without depression. METHOD: This observational study included 312,056 adult primary care patients at Kaiser Permanente Northern California who screened positive for unhealthy drinking between 2014 and 2017. Approximately half (48%) received a BI for alcohol use and 9% had depression. We examined 12-month changes in heavy drinking days in the previous three months, drinking days per week, drinks per drinking day, and drinks per week. Machine learning was used to estimate BI propensity, follow-up participation, and alcohol outcomes for an augmented inverse probability weighting (AIPW) estimator of the average treatment (BI) effect. This approach does not depend on the strong parametric assumptions of traditional logistic regression, making it more robust to model misspecification. RESULTS: BI had a significant effect on each alcohol use outcome in the non-depressed subgroup (-0.41 to -0.05, all ps < .003), but not in the depressed subgroup (-0.33 to -0.01, all ps > .28). However, differences between subgroups were nonsignificant (0.00 to 0.11, all ps > .44). CONCLUSION: On average, BI is an effective approach to reducing unhealthy drinking, but more research is necessary to understand its impact on patients with depression. AIPW with machine learning provides a robust method for comparing intervention effectiveness across subgroups.


Assuntos
Alcoolismo , Intervenção na Crise , Adulto , Consumo de Bebidas Alcoólicas/terapia , Alcoolismo/complicações , Alcoolismo/diagnóstico , Alcoolismo/terapia , Depressão/complicações , Depressão/terapia , Humanos , Aprendizado de Máquina , Atenção Primária à Saúde/métodos , Probabilidade
19.
Addict Sci Clin Pract ; 17(1): 49, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064466

RESUMO

BACKGROUND: There is an urgent need for interventions helping children affected by parental problematic alcohol consumption (PAC). Such interventions could target partners to individuals with PAC, partners who often themselves show impaired quality of life and mental health. The aim of this study was to investigate the efficacy of an online self-directed intervention combining components from Community Reinforcement Approach and Family Training (CRAFT) with a parenting training program for concerned significant others (CSOs) sharing a child with a co-parent with PAC. METHODS: A randomized controlled parallel-group superiority trial compared the efficacy of the online intervention for CSOs sharing a child (3-11 y/o) with a co-parent with PAC (N = 37), to an active control group (N = 39) receiving written psychoeducational material. Assessment of outcomes was conducted at baseline, 3 weeks, 8 weeks and 12 weeks. Primary outcome was children's mental health, while secondary outcomes included parental self-efficacy, CSO mental health and co-parent alcohol consumption and level of dependence. Linear mixed effect models with a factorial time variable were used to model time by group interaction effects. RESULTS: Recruitment rate was slow and a vast majority of interested CSOs were excluded at baseline assessment, mainly due experience of co-parent violence. The target sample size was not met. The intention to treat analysis did not show any significant time by group effects on either the primary or secondary outcomes during the follow-up period: the CSOs reported a significant reduction in co-parent alcohol consumption and severity of alcohol dependence and showed significant improvements in parental self-efficacy for how to handle effects of co-parent alcohol consumption, but no differences were found between the two conditions. CONCLUSIONS: The current study found no evidence supporting efficacy of a novel, online self-directed intervention on children's mental health, CSO mental health and co-parent alcohol related outcomes. Engaging in a support program or receiving information appears to initiate behavior change in the CSOs which affects the alcohol consumption and severity of dependence for co-parents with PAC. It is suggested that future studies may preferably focus on CSOs in more severely affected contexts. Trial registration The trial was pre-registered at isrctn.com reference number ISRCTN38702517, November 28, 2017.


Assuntos
Alcoolismo , Poder Familiar , Consumo de Bebidas Alcoólicas/terapia , Alcoolismo/psicologia , Alcoolismo/terapia , Criança , Humanos , Poder Familiar/psicologia , Pais/educação , Pais/psicologia , Qualidade de Vida
20.
JAMA Psychiatry ; 79(11): 1055-1064, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36129698

RESUMO

Importance: Despite the magnitude of alcohol use problems globally, treatment uptake remains low. Telephone-delivered interventions have potential to overcome many structural and individual barriers to help seeking, yet their effectiveness as a stand-alone treatment for problem alcohol use has not been established. Objective: To examine the effectiveness of the Ready2Change telephone-delivered intervention in reducing alcohol problem severity up to 3 months among a general population sample. Design, Setting, and Participants: This double-blind, randomized clinical trial recruited participants with an Alcohol Use Disorders Identification Test (AUDIT) score of greater than 6 (for female participants) and 7 (for male participants) from across Australia during the period of May 25, 2018, to October 2, 2019. Telephone assessments occurred at baseline and 3 months after baseline (84.9% retention). Data collection was finalized September 2020. Interventions: The telephone-based cognitive and behavioral intervention comprised 4 to 6 telephone sessions with a psychologist. The active control condition comprised four 5-minute telephone check-ins from a researcher and alcohol and stress management pamphlets. Main Outcomes and Measures: The primary outcome was change in alcohol problem severity, measured with the AUDIT total score. Drinking patterns were measured with the Timeline Followback (TLFB) instrument. Results: This study included a total of 344 participants (mean [SD] age, 39.9 [11.4] years; range, 18-73 years; 177 male participants [51.5%]); 173 participants (50.3%) composed the intervention group, and 171 participants (49.7%) composed the active control group. Less than one-third of participants (101 [29.4%]) had previously sought alcohol treatment, despite a high mean (SD) baseline AUDIT score of 21.5 (6.3) and 218 (63.4%) scoring in the probable dependence range. For the primary intention-to-treat analyses, there was a significant decrease in AUDIT total score from baseline to 3 months in both groups (intervention group decrease, 8.22; 95% CI, 7.11-9.32; P < .001; control group decrease, 7.13; 95% CI, 6.10-8.17; P < .001), but change over time was not different between groups (difference, 1.08; 95% CI, -0.43 to 2.59; P = .16). In secondary analyses, the intervention group showed a significantly greater reduction in the AUDIT hazardous use domain relative to the control group at 3 months (difference, 0.58; 95% CI, 0.02-1.14; P = .04). A greater reduction in AUDIT total score was observed for the intervention group relative to the control group when adjusting for exposure to 2 or more sessions (difference, 3.40; 95% CI, 0.36-6.44; P = .03) but not 1 or more sessions (per-protocol analysis). Conclusions and Relevance: Based on the primary outcome, AUDIT total score, this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control. However, the intervention was effective in reducing hazardous alcohol use and reduced alcohol problem severity when 2 or more sessions were delivered. Trial outcomes demonstrate the potential benefits of this highly scalable and accessible model of alcohol treatment. Trial Registration: ANZCTR Identifier: ACTRN12618000828224.


Assuntos
Alcoolismo , Humanos , Masculino , Feminino , Adulto , Alcoolismo/diagnóstico , Alcoolismo/terapia , Telefone , Etanol , Psicoterapia , Comportamentos Relacionados com a Saúde
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