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Rubio G, Esteban Rodríguez L, Sion A, Ramis Vidal L, Blanco MJ, Zamora-Bayon A, Caba-Moreno M, Macias-Molina AI, Pérez-Sánchez D, Rubio-Escobar E, Ruiz-Diez J, Marin M, Arias F, Lora D, Jurado-Barba R. How, when, and to what degree do people with alcohol dependence recover their psychological wellbeing and quality of life? The Madrid Recovery Project. Front Psychiatry 2023; 14:1130078. [PMID: 37398602 PMCID: PMC10313403 DOI: 10.3389/fpsyt.2023.1130078] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The consensus on recovery from alcohol use disorder (AUD) has shifted toward encompassing psychological wellbeing and quality of life dimensions. However, few studies have explored the long-term recovery process and its dimensions, timing, styles, and modes. The aim of this study was to investigate the extent, timing, and process of psychological wellbeing and quality of life recovery in alcohol use disorder (AUD) patients, as well as the relationship with classic dimensions of AUD recovery. Method A cross-sectional study has been carried out with 348 participants with AUD, in different abstinence periods (1 month-28 years), and 171 control subjects. Participants underwent a psychological evaluation, which included self-informed measures of psychological wellbeing, quality of life, negative emotionality, and coping strategies related to alcohol consumption avoidance. Statistical analysis included linear and non-linear regression models between psychological dimensions and maintenance of abstinence, as well as matching the scores of the sample with AUD to those of controls. Scatter plots were used to explore inflection points. In addition, mean comparison tests were performed between participants with AUD and controls and by gender. Results In general, according to the regression models, there were pronounced increases in indices of wellbeing and coping strategies (and pronounced decreases in negative emotionality) during the first 5 years of abstinence, followed by less pronounced improvements. The matching of AUD subjects in wellbeing and negative emotionality indices with controls occurs at different times: (a) 1 year or less: physical health; (b) 1-4 years: psychological health; (c) 4-10 years: social relationships, wellbeing, and negative emotionality; and (d) more than 10 years: autonomy and self-acceptance. There are statistically significant differences by gender for the negative emotionality and physical health variables. Conclusion Recovery from AUD is a long process that involves improvements in wellbeing and quality of life. Four stages can be described in this process, with the most pronounced changes occurring during the first 5 years of abstinence. However, AUD patients take more time to obtain similar scores to controls in several psychological dimensions.
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Affiliation(s)
- Gabriel Rubio
- Biomedical Research Institute, Hospital 12 de Octubre, Madrid, Spain
- Medicine Faculty, Complutense University of Madrid, Madrid, Spain
- Primary Care Research Network on Addictions (RIAPAd), Madrid, Spain
| | | | - Ana Sion
- Biomedical Research Institute, Hospital 12 de Octubre, Madrid, Spain
- Medicine Faculty, Complutense University of Madrid, Madrid, Spain
- Psychology Faculty, Complutense University of Madrid, Madrid, Spain
| | - Lilian Ramis Vidal
- Alcoholics Federation of the Community of Madrid (FACOMA), Madrid, Spain
| | - María J. Blanco
- Alcoholics Federation of the Community of Madrid (FACOMA), Madrid, Spain
| | | | - Marta Caba-Moreno
- Alcoholics Federation of the Community of Madrid (FACOMA), Madrid, Spain
| | | | | | | | - Joaquín Ruiz-Diez
- Alcoholics Federation of the Community of Madrid (FACOMA), Madrid, Spain
| | - Marta Marin
- Biomedical Research Institute, Hospital 12 de Octubre, Madrid, Spain
- Medicine Faculty, Complutense University of Madrid, Madrid, Spain
| | - Francisco Arias
- Biomedical Research Institute, Hospital 12 de Octubre, Madrid, Spain
- Medicine Faculty, Complutense University of Madrid, Madrid, Spain
| | - David Lora
- Biomedical Research Institute, Hospital 12 de Octubre, Madrid, Spain
- Faculty of Statistical Studies, Complutense University of Madrid, Madrid, Spain
| | - Rosa Jurado-Barba
- Biomedical Research Institute, Hospital 12 de Octubre, Madrid, Spain
- Medicine Faculty, Complutense University of Madrid, Madrid, Spain
- Department of Psychology, Education and Health Science Faculty, Camilo José Cela University, Madrid, Spain
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Di Nicola M, Pepe M, Panaccione I, Moccia L, Janiri L, Sani G. Update on Pharmacological Treatment for Comorbid Major Depressive and Alcohol Use Disorders: The Role of Extended-release Trazodone. Curr Neuropharmacol 2023; 21:2195-2205. [PMID: 37013426 PMCID: PMC10556391 DOI: 10.2174/1570159x21666230403080624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD) are major public health concerns because of their high prevalence and clinical and functional severity. MDD and AUD commonly co-occur, but effective therapeutic approaches for comorbidity are still scarce. Available evidence on selective serotonin reuptake inhibitors and tricyclic antidepressants held mixed results, and further pharmacological categories have been less investigated. Trazodone is an approved antidepressant drug for adults and has shown efficacy on symptoms like anxiety and insomnia observed in AUD patients as well. Thus, this study aims to evaluate the effect of extended-release trazodone on clinical and functional features in MDD + AUD subjects. METHODS One hundred MDD + AUD outpatients were retrospectively evaluated at 1, 3, and 6 months of treatment with extended-release trazodone (150-300 mg/day, flexibly dosed). Improvement in depressive symptoms was the primary outcome measure. Changes in anxiety, sleep, functioning, quality of life, clinical global severity, and alcohol craving were also investigated. RESULTS Trazodone reduced depressive symptoms (p < 0.001) with 54.5% remission at the endpoint. Similar improvements were observed in all secondary outcomes, including anxiety, sleep alterations, and craving (p < 0.001). Only mild side effects were reported and disappeared over time. CONCLUSION Extended-release trazodone displayed good antidepressant properties in MDD + AUD patients, ameliorating overall symptomatology, functioning, and quality of life, with a good safety/ tolerability profile. Further, it significantly improved sleep disturbances and craving symptoms, which are associated with drinking relapse and worse outcomes. Therefore, trazodone might represent a promising pharmacological option for MDD + AUD patients.
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Affiliation(s)
- Marco Di Nicola
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Pepe
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Lorenzo Moccia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
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