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Carlon HA, Hurlocker MC, Witkiewitz K. Mechanisms of quality-of-life improvement in treatment for alcohol use disorder. J Consult Clin Psychol 2022; 90:601-612. [PMID: 36066862 PMCID: PMC9899433 DOI: 10.1037/ccp0000750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE For individuals in alcohol use disorder (AUD) treatment, many argue that holistic indicators such as quality of life (QoL) should be more consistently used in addition to drinking-related indicators. QoL increases from pre- to post-AUD treatment, but the mechanisms are unclear. The present study examined the roles of positive and negative affect in QoL change during AUD treatment and additionally explored the relationship between QoL change and medication adherence. METHOD We examined the mediating roles of end-of-treatment positive affect (i.e., vigor) and negative affect (i.e., stress and tension) in the relationship between baseline (BL) and 26-week QoL among participants in the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence study randomized to medication management (MM; n = 468) or medication management plus combined behavioral intervention (MMCBI; n = 479) for AUD. We also explored whether changes in QoL were associated with medication adherence. RESULTS Change in psychological health QoL was mediated by increased vigor (i.e., positive affect) and decreased stress, and change in environmental QoL was mediated by decreased stress. There were also differences by treatment group, with stress mediating changes in environmental QoL among participants in MM, and vigor mediating changes in psychological health QoL among participants in MMCBI. Medication adherence was not associated with greater QoL after controlling for posttreatment alcohol use. CONCLUSIONS The present study identified potential mechanisms of QoL change in AUD treatment, thus contributing to the growing knowledge surrounding alternative indicators of treatment success for AUD treatment and recovery. Targeting affective states and stress during treatment may improve QoL and recovery outcomes for persons with AUD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Hannah A. Carlon
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Department of Psychology, Albuquerque, NM, 87131, USA
| | - Margo C. Hurlocker
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Department of Psychology, Albuquerque, NM, 87131, USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Department of Psychology, Albuquerque, NM, 87131, USA
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2
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Andersson HW, Nordfjærn T. Factors associated with quality of life trajectories among inpatients treated for alcohol use disorders: A prospective cohort study. Addict Behav Rep 2020; 12:100285. [PMID: 32637561 PMCID: PMC7330870 DOI: 10.1016/j.abrep.2020.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 12/05/2022] Open
Abstract
AIMS The main study purpose was to investigate patient- and treatment-related factors associated with overall quality of life (OQOL) trajectories during and after inpatient alcohol use disorder (AUD) treatment. DESIGN A large-scale prospective multicenter cohort study of patients with different substance use disorder (SUD) types who were consecutively admitted for inpatient SUD treatment. Data were obtained at treatment entry (T1), discharge (T2), three months after discharge (T3), and one year after discharge (T4). The inclusion criterion was that the patient be dependent solely on alcohol. OQOL data were collected at all four time points. Independent variables included demographics, mental distress, psychiatric disorders, substance use, treatment history, and patient satisfaction. RESULTS Among the 611 patients available, 236 met the AUD inclusion criterion and completed T1 assessments. A linear mixed model showed substantial co-occurrence between higher mental distress and lower OQOL. Higher patient satisfaction with inpatient treatment (T2) was associated with higher trajectories of OQOL, whereas abstinence (T3) was not. There was a substantial increase in OQOL from T1 to T2, which then remained stable during the last two assessment time points. CONCLUSIONS Routine OQOL screening at treatment entry, and targeting mental distress both during and after inpatient treatment, may be associated with improved OQOL among individuals with AUD. Further research should investigate inpatient treatment factors that contribute to OQOL improvement and those that moderate the relationship between patient satisfaction and OQOL.
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Affiliation(s)
- Helle Wessel Andersson
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Trond Nordfjærn
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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3
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Patterson T, Macleod E, Hobbs L, Egan R, Cameron C, Gross J. Measuring both primary and secondary outcomes when evaluating treatment effectiveness in alcohol and drug treatment programmes. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tess Patterson
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand,
| | - Emily Macleod
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand,
| | - Linda Hobbs
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand,
| | - Richard Egan
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand,
| | - Claire Cameron
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand,
| | - Julien Gross
- Department of Psychology, University of Otago, Dunedin, New Zealand,
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Huang H, Shen H, Ning K, Zhang R, Sun W, Li B, Jiang H, Wang W, Du J, Zhao M, Yi Z, Li J, Zhu R, Lu S, Xie S, Wang X, Fu W, Gao C, Hao W. Quality of Life and Its Correlates in Alcohol Use Disorder Patients With and Without Depression in China. Front Psychiatry 2020; 11:627338. [PMID: 33551885 PMCID: PMC7862321 DOI: 10.3389/fpsyt.2020.627338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/28/2020] [Indexed: 02/05/2023] Open
Abstract
Objective: Alcohol use disorder (AUD) is a serious issue worldwide and frequently co-occurs with depression. However, the quality of life (QOL) of AUD patients with and without depression is not well studied in the Chinese Han population. The aim of this study was to investigate QOL and its correlates in AUD patients with and without depression in China. Methods: Five hundred and fifteen psychiatric patients diagnosed with AUD were recruited. All these patients completed the Beck Depression Inventory (BDI) to assess depression, the Medical Outcome Study 36-Item Short Form Health Survey (SF-36) to evaluate QOL and the Alcohol Use Disorders Identification Test (AUDIT) to measure the severity of drinking. Results: Compared with AUD patients without depression, those with depression had a lower QOL in all eight domains of the SF-36 (all P < 0.001), but were more willing to have alcohol-related treatment (P < 0.05). Negative correlations were noted between (i) the BDI total score and all eight domains of the SF-36 (all P < 0.001); and (ii) between the AUDIT total score and six domains of the SF-36 (all P < 0.05). Conclusions: Depression impairs QOL in patients with AUD in China. Early intervention in comorbid depression to improve QOL is needed.
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Affiliation(s)
- Hui Huang
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Hongxian Shen
- Key Laboratory of Psychiatry and Mental Health of Hunan Province, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Kui Ning
- Henan Mental Hospital, Xinxiang, China
| | | | - Wei Sun
- Peking University Sixth Hospital, Beijing, China
| | - Bing Li
- Peking University Sixth Hospital, Beijing, China
| | | | | | - Jiang Du
- Shanghai Mental Health Center, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai, China
| | - Zhihua Yi
- West China Hospital, Sichuan University, Chengdu, China
| | - Jing Li
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | | | - Wei Fu
- The First Affiliated Hospital of Xian Jiaotong University, Xian, China
| | - Chengge Gao
- The First Affiliated Hospital of Xian Jiaotong University, Xian, China
| | - Wei Hao
- Key Laboratory of Psychiatry and Mental Health of Hunan Province, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
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5
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Witkiewitz K, Roos CR, Tofighi D, Van Horn ML. Broad Coping Repertoire Mediates the Effect of the Combined Behavioral Intervention on Alcohol Outcomes in the COMBINE Study: An Application of Latent Class Mediation. J Stud Alcohol Drugs 2019; 79:199-207. [PMID: 29553346 DOI: 10.15288/jsad.2018.79.199] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Few studies have found support for coping as a mechanism of behavior change (MOBC) following coping skills training interventions for alcohol use disorder (AUD). One potential reason for null findings is heterogeneity in the patterns of coping skills acquired during treatment. This study sought to identify latent classes of coping and to test the latent class variable as a mediator of the effect of a combined behavioral intervention for AUD. METHOD Secondary analyses of data from the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study (N = 1,124; mean age = 44.4 years; 69.1% male; 23.2% non-White), a multisite study of medication and behavioral treatments for individuals with AUD. Latent class mediation models were estimated to test whether patterns of alcohol-specific coping mediated the effect of combined behavioral intervention with medication management, as compared with medication management only, on drinking outcomes 12 months following treatment. RESULTS Three classes were identified, which differed in repertoire broadness, or the degree in which a wide range of different skills were used. Coping repertoire class was a significant mediator of the effect of the combined behavioral intervention on drinking outcomes. Receiving the combined behavioral intervention, in addition to medication management, predicted a greater likelihood of expected classification in the broad coping repertoire class, which in turn was associated with significant improvements in drinking outcomes. CONCLUSIONS Using the novel methodological approach of latent class mediation, this study identified coping repertoire as a significant mediator of behavioral intervention efficacy for AUD. Future work examining heterogeneity in mediators and outcomes may help refine AUD treatment to be maximally effective.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Corey R Roos
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Davood Tofighi
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - M Lee Van Horn
- Department of Individual, Family and Community Education, University of New Mexico, Albuquerque, New Mexico.,The Methodology Group @ UNM, University of New Mexico, Albuquerque, New Mexico
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6
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Macfarlane VFH, Prentice DA, Walsh MS. The Auckland alcohol detoxification outcome study: Measuring changes in quality of life in individuals completing a medicated withdrawal from alcohol in a detoxification unit. Drug Alcohol Depend 2019; 202:156-161. [PMID: 31352304 DOI: 10.1016/j.drugalcdep.2018.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 11/17/2018] [Accepted: 11/21/2018] [Indexed: 11/27/2022]
Abstract
AIM To measure outcomes in Quality of Life in alcohol dependent patients' following a medicated withdrawal from alcohol. METHODS 79 patients that were admitted to a detoxification unit in Auckland, New Zealand between March 2016 and September 2016 were assessed for severity of alcohol dependence using the Alcohol Use Disorders Identification Test (AUDIT) and Severity of Alcohol Dependency Questionnaire (SADQ) and Quality of Life (QOL) using the World Health Organisation Quality of Life-abbreviated version of the WHOQOL 100 New Zealand version (WHOQOL-BREF NZ). Patients were followed up at three months and 12 months and an estimate of drinking behavior and the WHO-QOL BREF NZ were completed via telephone interview. QOL domain scores were assessed from baseline to three months and baseline to 12 months in both relapse and abstinent groups. At three months, a single question was asked in order to collect qualitative data. RESULTS At baseline, the study population had statistically significantly lower mean QOL domain scores than scores reported from the general population. QOL improved in patients following detoxification at three months and 12 months in both the relapse and abstinent groups; however, the change in scores from baseline was greater in the abstinent group compared to the relapse group. The majority of patients reported that the admission had been a positive experience. CONCLUSION QOL improves in individuals following a medicated withdrawal from alcohol regardless of whether individual's relapse; however, those that remain abstinent have greater improvements in quality of life.
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Affiliation(s)
- Vicki F H Macfarlane
- Community Alcohol and Drug Services, Waitemata District Health Board, 50 Carrington Rd, Auckland, 1025, New Zealand.
| | - David A Prentice
- Community Alcohol and Drug Services, Waitemata District Health Board, 50 Carrington Rd, Auckland, 1025, New Zealand.
| | - Michael S Walsh
- Planning, Funding and Outcomes, Waitemata and Auckland District Health Boards, 44 Taharoto Rd, Auckland, New Zealand.
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7
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Ekmekci Ertek I, Taner ME, Nazik Yüksel R, Ozan Kotan V, Göka E. Quality of life and pain perception in alcohol dependence: A comparative examination of patients, their relatives, and healthy controls. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1612473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Irem Ekmekci Ertek
- Department of Psychiatry, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Ender Taner
- Department of Psychiatry, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Rabia Nazik Yüksel
- Department of Psychiatry, Numune Education and Research Hospital, Ankara, Turkey
| | - Vahap Ozan Kotan
- Department of Psychiatry, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Erol Göka
- Department of Psychiatry, Numune Education and Research Hospital, Ankara, Turkey
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8
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Tanaree A, Assanangkornchai S, Isaranuwatchai W, Thavorn K, Coyte PC. Integrated treatment program for alcohol related problems in community hospitals, Songkhla province of Thailand: A social return on investment analysis. PLoS One 2019; 14:e0209210. [PMID: 30601850 PMCID: PMC6314591 DOI: 10.1371/journal.pone.0209210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/30/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To estimate the impacts and social value relative to the cost of the Integrated Management of Alcohol Intervention Program in the Health Care System (i-MAP) on direct beneficiaries, using a Social Return on Investment (SROI) analysis. METHOD A mixed-method approach was conducted among stakeholders and 113 drinkers (29 low-risk, 43 high-risk, and 41 dependent drinkers) who consecutively received i-MAP at four community hospitals in Songkhla province of Thailand. Resources for program implementation as well as drinking and a list of psychosocial outcomes, selected through stakeholder interviews, were measured among participants during and at the sixth month after participation, respectively. SROI (societal benefit-to-cost) ratio of i-MAP was estimated over a 5-year time horizon and shown in 2017 Thai baht, where US$1.00 = 33.1 baht. One-way and probabilistic sensitivity analyses of key parameters were performed among treatment subgroups. RESULTS Baseline estimates of the annual cost and 5-year social value of i-MAP were 25.5 and 51.0 million baht, respectively, yielding an estimated SROI ratio of 2.0, with a possible range of 1.3 to 2.4. Value created by the program was mostly attributed to broader gains to society (productivity gains and averted crime costs) and drinkers. Subgroup analyses suggested that the SROI ratio for high-risk drinkers was twice that for dependent drinkers (2.8 vs. 1.5). The probabilistic sensitivity analysis showed that more than 99% of the simulated treatments for both high-risk and dependent groups yielded benefits beyond the corresponding costs. CONCLUSIONS By considering societal perspective, the i-MAP program has demonstrated its social value is twice its investment cost and potential for the program to be implemented nationwide.
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Affiliation(s)
- Athip Tanaree
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, Canada
| | - Peter C. Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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9
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Witkiewitz K, Kranzler HR, Hallgren KA, O'Malley SS, Falk DE, Litten RZ, Hasin DS, Mann KF, Anton RF. Drinking Risk Level Reductions Associated with Improvements in Physical Health and Quality of Life Among Individuals with Alcohol Use Disorder. Alcohol Clin Exp Res 2018; 42:2453-2465. [PMID: 30395350 PMCID: PMC6286196 DOI: 10.1111/acer.13897] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/24/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abstinence and no heavy drinking days are currently the only Food and Drug Administration-approved end points in clinical trials for alcohol use disorder (AUD). Many individuals who fail to meet these criteria may substantially reduce their drinking during treatment, and most individuals with AUD prefer drinking reduction goals. One- and two-level reductions in World Health Organization (WHO) drinking risk levels have been proposed as alternative end points that reflect reduced drinking and are associated with reductions in drinking consequences, improvements in mental health, and reduced risk of developing alcohol dependence. The current study examined the association between WHO drinking risk level reductions and improvements in physical health and quality of life in a sample of individuals with alcohol dependence. METHODS Secondary data analysis of individuals with alcohol dependence (n = 1,142) enrolled in the longitudinal, prospective COMBINE study, a multi site randomized placebo-controlled clinical trial, examining the association between reductions in WHO drinking risk levels and change in blood pressure, liver enzyme levels, and self-reported quality of life following treatment for alcohol dependence. RESULTS One- and two-level reductions in WHO drinking risk level during treatment were associated with significant reductions in systolic blood pressure (p < 0.001), improvements in liver enzyme levels (all p < 0.01), and significantly better quality of life (p < 0.001). CONCLUSIONS One- and two-level reductions in WHO drinking risk levels predicted significant improvements in markers of physical health and quality of life, suggesting that the WHO drinking risk level reduction could be a meaningful surrogate marker of improvements in how a person "feels and functions" following treatment for alcohol dependence. The WHO drinking risk levels could be useful in medical practice for identifying drinking reduction targets that correspond with clinically significant improvements in health and quality of life.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology , University of New Mexico, Albuquerque, New Mexico
| | - Henry R Kranzler
- Department of Psychiatry , University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences , University of Washington, Seattle, Washington
| | | | - Daniel E Falk
- National Institute on Alcohol Abuse and Alcoholism , Bethesda, Maryland
| | - Raye Z Litten
- National Institute on Alcohol Abuse and Alcoholism , Bethesda, Maryland
| | - Deborah S Hasin
- Department of Epidemiology , Columbia University, New York, New York
| | - Karl F Mann
- Medical Faculty Mannheim , Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina, Charleston, South Carolina
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Karriker-Jaffe KJ, Witbrodt J, Subbaraman MS, Kaskutas LA. What Happens After Treatment? Long-Term Effects of Continued Substance Use, Psychiatric Problems and Help-Seeking on Social Status of Alcohol-Dependent Individuals. Alcohol Alcohol 2018; 53:394-402. [PMID: 29617709 PMCID: PMC6016698 DOI: 10.1093/alcalc/agy025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 11/14/2022] Open
Abstract
PURPOSE We examined whether alcohol-dependent individuals with sustained substance use or psychiatric problems after completing treatment were more likely to experience low social status and whether continued help-seeking would improve outcomes. SHORT SUMMARY Ongoing alcohol, drug and psychiatric problems after completing treatment were associated with increased odds of low social status (unemployment, unstable housing and/or living in high-poverty neighborhood) over 7 years. The impact of drug problems declined over time, and there were small, delayed benefits of AA attendance on social status. METHOD Alcohol-dependent individuals sampled from public and private treatment programs (N = 491; 62% male) in Northern California were interviewed at treatment entry and 1, 3, 5 and 7 years later. Random effects models tested relationships between problem severity (alcohol, drug and psychiatric problems) and help-seeking (attending specialty alcohol/drug treatment and Alcoholics Anonymous, AA) with low social status (unemployment, unstable housing and/or living in a high-poverty neighborhood) over time. RESULTS The proportion of participants experiencing none of the indicators of low social status increased between baseline and the 1-year follow-up and remained stable thereafter. Higher alcohol problem scores and having any drug and/or psychiatric problems in the years after treatment were associated with increased odds of low social status over time. An interaction of drug problems with time indicated the impact of drug problems on social status declined over the 7-year period. Both treatment-seeking and AA attendance were associated with increased odds of low social status, although lagged models suggested there were small, delayed benefits of AA attendance on improved social status over time. CONCLUSION Specialty addiction treatment alone was not sufficient to have positive long-term impacts on social status and social integration of most alcohol-dependent people.
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Affiliation(s)
| | - Jane Witbrodt
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450 Emeryville, CA, USA
| | - Meenakshi S Subbaraman
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450 Emeryville, CA, USA
| | - Lee Ann Kaskutas
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450 Emeryville, CA, USA
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11
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Gür F, Can Gür G, Okanlı A. The Effect of the Cognitive-behavioral Model-based Psychoeducation and Exercise Intervention on Quality of Life in Alcohol Use Disorder. Arch Psychiatr Nurs 2017; 31:541-548. [PMID: 29179818 DOI: 10.1016/j.apnu.2017.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/12/2017] [Accepted: 07/15/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of the study was to assess the effect of the cognitive behavior model (CBM)-based psychoeducation and exercise intervention on quality of life (QoL) in alcohol use disorder (AUD). DESIGN This study was a non-randomized controlled trial. METHODS CBM-based psychoeducation and exercise intervention was applied to the experimental group four times a week for 6weeks; no intervention was applied to the control group. FINDINGS No difference was seen between the points of pretest QoL of the experimental and control groups (p>0.05). However, according to the posttest, the experimental group's mean score of QoL was higher than the control groups (p<0.05). CONCLUSION It was found that CBM-based psychoeducation and exercise intervention applied to individuals with AUD affected the QoL positively. CLINICAL RELEVANCE CBM-based psychoeducation and exercise intervention can be used by nurses to improve AUD individuals' quality of life.
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Affiliation(s)
- Fatih Gür
- University of Karadeniz Technical, Faculty of Sport Science, Trabzon 61000, Turkey.
| | - Ganime Can Gür
- University of Atatürk, Faculty of Health Science, Department of Psychiatric Nursing, Erzurum 25000, Turkey.
| | - Ayşe Okanlı
- University of Medeniyet, Faculty of Health Science, Department of Psychiatric Nursing, İstanbul 34710, Turkey
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12
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Bold KW, Epstein EE, McCrady BS. Baseline health status and quality of life after alcohol treatment for women with alcohol dependence. Addict Behav 2017; 64:35-41. [PMID: 27543832 PMCID: PMC5143167 DOI: 10.1016/j.addbeh.2016.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/13/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Research suggests that women with alcohol use disorders (AUDs) experience more severe medical and social consequences from alcohol use compared to men, but little is known about health improvements following alcohol treatment. METHODS This study sought to characterize the pre-treatment health status of 138 alcohol dependent women enrolled in 12 sessions of female-specific group or individual outpatient treatment and examine the degree to which alcohol treatment might promote positive quality of life changes. Quality of life was assessed using the World Health Organization Quality of Life measure at baseline and 3months later at the end of treatment. RESULTS The most common health problems at baseline were: smoking cigarettes (34.1%), hypertension (31.2%), obesity (27.5%), arthritis (21.0%), high cholesterol (17.4%), heart problems (8.7%), and a history of cancer (7.2%). Significant improvements across physical, t(117)=4.67, p<0.001, d=0.42; psychological, t(117)=7.31, p<0.001, d=0.62; social, t(117)=3.18, p=0.002, d=0.28; and environmental, t(117)=2.39, p=0.018, d=0.17; quality of life domains were seen after treatment. Percent days abstinent during treatment was positively associated with overall health satisfaction and psychological health at the end of treatment. CONCLUSIONS Women presenting for outpatient treatment for alcohol use disorders report many comorbid negative health problems. Thus, it is important for both substance use and health care providers to consider the overlap of alcohol use problems and health domains. Furthermore, female-specific cognitive behavioral treatment for alcohol use disorders positively impacted multiple health domains for women, suggesting a potential transdiagnostic intervention to target co-occurring health and substance use problems.
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Affiliation(s)
- Krysten W Bold
- Rutgers, the State University of New Jersey, Center of Alcohol Studies, 607 Allison Road, Piscataway, NJ 08854, United States; Yale School of Medicine, Department of Psychiatry, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519, United States.
| | - Elizabeth E Epstein
- Rutgers, the State University of New Jersey, Center of Alcohol Studies, 607 Allison Road, Piscataway, NJ 08854, United States; University of Massachusetts School of Medicine, Department of Psychiatry, Biotech One, 365 Plantation Street, Worcester, MA 01605, United States
| | - Barbara S McCrady
- University of New Mexico, Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale SE, Albuquerque, NM 87106, United States
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13
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Gueorguieva R, Wu R, Fucito LM, O'Malley SS. Predictors of Abstinence From Heavy Drinking During Follow-Up in COMBINE. J Stud Alcohol Drugs 2016; 76:935-41. [PMID: 26562602 DOI: 10.15288/jsad.2015.76.935] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Although the primary focus of clinical trials is on between-group comparisons during treatment, these studies can also yield insights into which patient characteristics predict longer term outcomes. Our goal was to identify predictors of good outcome during the 1-year follow-up in the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study. METHOD We constructed classification trees and a deterministic forest to predict no heavy drinking days during the last 8 weeks of the 1-year follow-up in COMBINE, based on more than 100 baseline predictors and drinking outcomes during the treatment phase of the study. The COMBINE sample was randomly split into a training and a validation data set. Logistic regression models were fit to compare the predictive performance of tree-based methods and classical methods. RESULTS A small tree with only two splits and four nodes based on abstinence and good clinical outcome during treatment had fair classification accuracy in the training and the validation samples: area under the curve (AUC) of 71% and 70%, respectively. Drinking outcomes during treatment were the strongest predictors in the deterministic forest. Logistic regression analyses based on four main effects (good clinical outcome, level of drinking during treatment, age at onset of alcohol dependence, and feeling more energetic) had slightly better classification accuracy (AUC = 74%). CONCLUSIONS End-of-treatment outcomes were the strongest predictors of long-term outcome in all analyses. The results emphasize the importance of optimizing outcomes during treatment and identify potential subgroups of individuals who require additional or alternative interventions to achieve good long-term outcome.
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Affiliation(s)
- Ralitza Gueorguieva
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut
| | - Ran Wu
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Lisa M Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Stephanie S O'Malley
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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Witkiewitz K, Finney JW, Harris AH, Kivlahan DR, Kranzler HR. Recommendations for the Design and Analysis of Treatment Trials for Alcohol Use Disorders. Alcohol Clin Exp Res 2015; 39:1557-70. [PMID: 26250333 PMCID: PMC4558228 DOI: 10.1111/acer.12800] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/30/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Over the past 60 years, the view that "alcoholism" is a disease for which the only acceptable goal of treatment is abstinence has given way to the recognition that alcohol use disorders (AUDs) occur on a continuum of severity, for which a variety of treatment options are appropriate. However, because the available treatments for AUDs are not effective for everyone, more research is needed to develop novel and more efficacious treatments to address the range of AUD severity in diverse populations. Here we offer recommendations for the design and analysis of alcohol treatment trials, with a specific focus on the careful conduct of randomized clinical trials of medications and nonpharmacological interventions for AUDs. METHODS This paper provides a narrative review of the quality of published clinical trials and recommendations for the optimal design and analysis of treatment trials for AUDs. RESULTS Despite considerable improvements in the design of alcohol clinical trials over the past 2 decades, many studies of AUD treatments have used faulty design features and statistical methods that are known to produce biased estimates of treatment efficacy. CONCLUSIONS The published statistical and methodological literatures provide clear guidance on methods to improve clinical trial design and analysis. Consistent use of state-of-the-art design features and analytic approaches will enhance the internal and external validity of treatment trials for AUDs across the spectrum of severity. The ultimate result of this attention to methodological rigor is that better treatment options will be identified for patients with an AUD.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - John W. Finney
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA
| | - Alex H.S Harris
- VA Substance Use Disorder Quality Enhancement Research Initiative, VA Palo Alto Health Care System, Menlo Park, CA
| | - Daniel R. Kivlahan
- Veterans Health Administration, Washington, DC and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Henry R. Kranzler
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine and VISN4 MIRECC, Philadelphia VAMC, Philadelphia, PA
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Levola J, Aalto M, Holopainen A, Cieza A, Pitkänen T. Health-related quality of life in alcohol dependence: a systematic literature review with a specific focus on the role of depression and other psychopathology. Nord J Psychiatry 2014; 68:369-84. [PMID: 24228776 DOI: 10.3109/08039488.2013.852242] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is considered a valid measure of treatment effectiveness in addictions. However, alcohol research has lagged behind other biomedical fields in using HRQOL outcomes as primary or secondary endpoints. Previous work has suggested that psychiatric co-morbidity may mediate the relationship between alcohol dependence and HRQOL. AIM The goal was to summarize the literature on HRQOL and its domains in the context of alcohol dependence. A specific focus was on the impact of depression and other psychopathology on these areas of life. MATERIALS AND METHODS A database search of MEDLINE and PsychINFO was performed within the scope of PARADISE (Psychosocial fActors Relevant to brAin DISorders in Europe); a European Commission funded coordination action. Using pre-defined eligibility criteria, 42 studies were identified. A systematic approach to data collection was employed. RESULTS AND CONCLUSIONS Alcohol dependence was shown to affect overall HRQOL and its domains, including general health, physical and mental health, general and social functioning, activities of daily living, pain and sleep. The evidence demonstrating that alcohol dependence is a primary cause of impairments in overall HRQOL, general health, mental and physical health and social functioning was fairly strong. Treatment interventions helped improve HRQOL and its aforementioned domains. The reduction or cessation of alcohol use facilitated these improvements; however, it was not reported to be predictive of improvement in all instances where improvement was reported. Depression was associated with further decreases in HRQOL. Personality disorders contributed to the severity of social functioning impairment.
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Affiliation(s)
- Jonna Levola
- Jonna Levola, A-clinic Foundation, Research Unit ; Helsinki , Finland , and National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services ; Helsinki , Finland
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Quality of life, alcohol detoxification and relapse: is quality of life a predictor of relapse or only a secondary outcome measure? Qual Life Res 2014; 23:2757-67. [PMID: 24929832 DOI: 10.1007/s11136-014-0735-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To estimate variations in Overall Quality Of Life (OQOL) within 12 months following alcohol detoxification and to evaluate the predictive value of OQOL for relapse and alcohol use severity. METHODS Alcohol use disorders and four OQOL domains (physical health, psychological health, social relationships and environment) were assessed in 199 patients entering in-patient alcohol detoxification. Follow-up assessments were performed at 6 and 12 months after discharge. Cross-sectional and longitudinal analyses explored the relationship between OQOL and alcohol use severity, examining differences between abstinent and relapsed patients. The predictive value of OQOL was analyzed by logistic and linear regression. RESULTS Correlation between OQOL and Alcohol Use Disorders Identification Test scores was confirmed at all stages of observation. Abstinent patients showed a significant improvement in all OQOL domains at 6 months after discharge, whereas OQOL domains did not undergo any significant change in relapsed patients. Baseline OQOL did not prove to be predictive of either relapse or alcohol use severity. CONCLUSIONS Overall quality of life changed in parallel with alcohol use severity throughout the duration of the study, confirming it to be a useful and sensitive measure of secondary outcome for alcohol detoxification. Conversely, none of the OQOL baseline scores functioned as predictors of relapse within 12 months following discharge or alcohol use severity in relapsed patients.
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Levola J, Kaskela T, Holopainen A, Sabariego C, Tourunen J, Cieza A, Pitkänen T. Psychosocial difficulties in alcohol dependence: a systematic review of activity limitations and participation restrictions. Disabil Rehabil 2013; 36:1227-39. [DOI: 10.3109/09638288.2013.837104] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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DeSantis SM, Bandyopadhyay D, Baker NL, Randall PK, Anton RF, Prisciandaro JJ. Modeling longitudinal drinking data in clinical trials: an application to the COMBINE study. Drug Alcohol Depend 2013; 132:244-50. [PMID: 23566774 PMCID: PMC4025907 DOI: 10.1016/j.drugalcdep.2013.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 02/04/2013] [Accepted: 02/08/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a lack of consensus in the literature as to how to define drinking outcomes in clinical trials. Typically, separate statistical models are fit to assess treatment effects on several summary drinking measures. These summary measures do not capture the complexity of drinking behavior. We used the COMBINE study to illustrate a statistical approach for examining treatment effects on high-resolution drinking data. METHODS This is a secondary data analysis of COMBINE participants randomly assigned to naltrexone, acamprosate, with medical management and/or combined behavioral intervention (CBI). Using a Poisson hurdle model, abstinence and number of drinks were simultaneously modeled as a function of treatment and covariates. An emphasis was placed on the evaluation of "risky drinking" (3 drinks/day for women and 4 for men). RESULTS During treatment, naltrexone increased the odds of abstinence vs placebo naltrexone (OR=1.35 [1.06, 1.65]) but receiving CBI in addition to naltrexone (vs not) obscured this effect; thus, the naltrexone effect was largest in the group not receiving CBI (OR=1.87 [1.29, 2.46]). Naltrexone vs placebo naltrexone also reduced the risk of drinking in those who resumed risky drinking (RR=0.58 [0.24, 0.93]) and increased the odds of maintaining low risk drinking (OT=1.99 [1.07, 2.90]). Both effects were strongest in the absence of CBI when only "medical management" was provided. CONCLUSIONS The hurdle model is an appropriate statistical tool for assessing the effect of treatment on the two part drinking process, abstinence and number of drinks. When applied to COMBINE, results bolster the use of naltrexone in promoting abstinence and reduction in risky drinking.
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Affiliation(s)
- Stacia M DeSantis
- University of Texas Health Sciences Center, 1200 Herman Pressler Dr, Houston, TX 77030, United States.
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Franck J, Jayaram-Lindström N. Pharmacotherapy for alcohol dependence: status of current treatments. Curr Opin Neurobiol 2013; 23:692-9. [DOI: 10.1016/j.conb.2013.05.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/26/2013] [Accepted: 05/30/2013] [Indexed: 11/28/2022]
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Frischknecht U, Sabo T, Mann K. Improved Drinking Behaviour Improves Quality of Life: A Follow-Up in Alcohol-Dependent Subjects 7 Years After Treatment. Alcohol Alcohol 2013; 48:579-84. [DOI: 10.1093/alcalc/agt038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Trim RS, Schuckit MA, Smith TL. Predictors of initial and sustained remission from alcohol use disorders: findings from the 30-year follow-up of the San Diego Prospective Study. Alcohol Clin Exp Res 2013; 37:1424-31. [PMID: 23458300 DOI: 10.1111/acer.12107] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 12/12/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Individuals who report problematic drinking early in life often recover from alcohol-related disorders, with or without formal treatment. While risk factors associated with developing alcohol use disorders (AUDs), such as a family history of alcoholism and the genetically influenced low level of response (LR) to alcohol, have been identified, less is known about characteristics that relate to remission from AUDs. METHODS The male subjects (98% Caucasian) for this study were 129 probands from the San Diego Prospective Study who were first evaluated at age 20 as drinking but not alcohol-dependent young men, most of whom were college graduates by follow-up. The individuals evaluated here met criteria for an AUD at their first follow-up at ages 28 to 33 and were followed every 5 years for the next 2 decades. Discrete-time survival analysis was used to examine rates of initial and sustained AUD remission and to evaluate the relationships of premorbid characteristics and other risk factors to these outcomes. RESULTS Sixty percent of the sample met criteria for an initial AUD remission of 5 or more years, including 45% with sustained remission (i.e., no subsequent AUD diagnosis). Higher education, lower drinking frequency, and having a diagnosis of alcohol abuse (rather than dependence) were associated with higher rates of initial AUD remission. A lower LR to alcohol at age 20, as well as lower drinking frequency, having received formal alcohol treatment, and older age at the first follow-up all predicted a greater likelihood of sustained AUD remission. CONCLUSIONS This study identified key factors associated with initial and sustained AUD remission in subjects diagnosed with AUD in young adulthood. Characteristics associated with better outcomes early in the life span, such as lower drinking frequency and early treatment, appear to have a lasting impact on remission from AUD across adulthood.
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Affiliation(s)
- Ryan S Trim
- VA San Diego Healthcare System, San Diego, CA, USA
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Abstract
LEARNING OBJECTIVES After participating in this educational activity, the reader should be better able to identify the instruments that are currently being used to measure quality of life (QoL) in alcohol abuse and dependence; determine the impact of alcohol abuse and dependence on QoL; and evaluate the impact of treating alcohol abuse and dependence on QoL. OBJECTIVE Quality of life, which consists of the physical, mental, and social domains, has been shown to be negatively affected by alcohol abuse and dependence. This review aims to examine QoL in alcohol abuse and dependence by reviewing the instruments used to measure it and by analyzing the impact of alcohol abuse and dependence and of treatment on QoL. METHODS Studies were identified using a database search of PubMed and PsycINFO from the past 40 years (1971-2011) using the following keywords: abuse OR dependence, OR use AND alcohol, AND Quality of Life, QoL, Health-related quality of life, HRQOL. Two authors agreed independently on including 50 studies that met specific selection criteria. RESULTS Although several global measures of QoL have established reliability and validity, many alcohol-specific measures of QoL have not yet been validated. Nevertheless, QoL has been shown to be significantly impaired in those with alcohol abuse and dependence, particularly in the domains of mental health and social functioning, the very areas that show the greatest improvement with abstinence and its maintenance. Moreover, the literature demonstrates the utility of using QoL measures throughout assessment and treatment as a motivational tool and as a marker for treatment efficacy. CONCLUSIONS Measuring and monitoring QoL during assessment and treatment can add important value to patient recovery, for QoL improves with treatment and successful abstinence. Therefore, targeted, disease-specific assessments of QoL are warranted to address the impairments in the physical, mental, and social domains in alcohol abuse and dependence, thereby improving long-term outcomes.
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Luquiens A, Reynaud M, Falissard B, Aubin HJ. Quality of life among alcohol-dependent patients: how satisfactory are the available instruments? A systematic review. Drug Alcohol Depend 2012; 125:192-202. [PMID: 22939877 DOI: 10.1016/j.drugalcdep.2012.08.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 08/10/2012] [Accepted: 08/11/2012] [Indexed: 01/22/2023]
Abstract
AIM The purpose of this systematic review was to compare quality-of-life instruments used as outcome measures in randomized clinical trials for alcohol-dependence treatment. METHODS Randomized controlled clinical trials, indexed in the EMBASE, PubMed and PsycINFO databases since 1981, which aimed at improving the quality of life in alcohol-dependent patients and used as instrument to measure the quality of life, as specifically designated by the authors, were included. RESULTS Of the 331 articles screened, 18 studies were included in the review. Eight different quality-of-life instruments were used as outcome measures. Twenty-seven life domains were explored. Between-scale heterogeneity was high. The scale most frequently used was the medical outcomes study 36-item short-form health survey (SF-36). Only 1 clinical trial demonstrated a significant difference between intervention groups at all endpoints, using the quality of life enjoyment and satisfaction questionnaire (Q-LES-Q). CONCLUSION Because many different instruments were used, it is difficult to compare quality-of-life improvement between trials. The most frequently used instrument was a generic health status measure that may not be well suited as a quality-of-life measure for subjects with alcohol dependence. The construction and validation of a specific patient-reported outcome based on alcohol-dependent patients' concerns would effectively contribute to the assessment of treatment efficacy.
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Affiliation(s)
- A Luquiens
- Hôpital Paul Brousse, Univ Paris-Sud, INSERM U669, 94804 Villejuif, France.
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Prisciandaro JJ, DeSantis SM, Bandyopadhyay D. Simultaneous modeling of the impact of treatments on alcohol consumption and quality of life in the COMBINE study: a coupled hidden Markov analysis. Alcohol Clin Exp Res 2012; 36:2141-9. [PMID: 22551231 DOI: 10.1111/j.1530-0277.2012.01823.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 02/27/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Clinical trials for alcoholism have historically regarded alcohol consumption as the primary outcome. In a subset of trials, quality of life (QOL) has been considered as a secondary outcome. Joint latent-variable modeling techniques may provide a more accurate and powerful simultaneous analysis of primary and secondary outcomes in clinical trials. The goal of this study was to evaluate longitudinal associations between treatment status, alcohol consumption, and QOL in the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study. METHODS A total of 1,383 alcohol-dependent patients were randomized to 9 treatment groups. Percent heavy drinking days (PHDD) and health-related QOL from the 30 days preceding baseline, week 16, and week 52 were calculated using the Form 90 and the Medical Outcomes Study Health Survey Short Form-12 (SF-12), respectively. Latent profile analysis (LPA) was conducted to determine an appropriate number of latent states to represent PHDD and QOL. Subsequently, univariate and coupled hidden Markov models (for PHDD and SF-12 mental health, and PHDD and SF-12 physical) were fit to the data. RESULTS LPA suggested that PHDD should be represented by 3 latent states and that each SF-12 scale should be represented by 2 states. Joint modeling results suggested that (i) naltrexone significantly predicted decreased PHDD (p < 0.05), and marginally predicted improved mental health QOL via decreased PHDD (p < 0.10), and (ii) that the combinations of naltrexone and combined behavioral intervention (CBI), and acamprosate and CBI, each predicted significantly improved physical QOL (p < 0.05), and marginally predicted decreased PHDD via improved physical QOL (p < 0.10). CONCLUSIONS This study illustrates a powerful and novel statistical approach for simultaneously evaluating the impact of treatments on primary and secondary outcomes in clinical trials. This study also suggests that behavioral interventions may impact drinking behavior through their ameliorative effects on QOL.
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Affiliation(s)
- James J Prisciandaro
- Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
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Donovan DM. More mice or a better mouse trap? Reflections on primary outcome indices in illicit drug dependence treatment research. Addiction 2012; 107:723-4. [PMID: 22372701 DOI: 10.1111/j.1360-0443.2012.03784.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hartzler B, Witkiewitz K, Villarroel N, Donovan D. Self-efficacy change as a mediator of associations between therapeutic bond and one-year outcomes in treatments for alcohol dependence. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2011; 25:269-78. [PMID: 21443293 DOI: 10.1037/a0022869] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Empirically-supported treatments for alcohol dependence exist, yet understanding of influences contributing to the intended behavior change is limited. The current study, a secondary analysis of the recent multisite COMBINE trial (The COMBINE Study Research Group, 2003), tested a mediational model wherein change in client self-efficacy for abstinence was examined as a potential mediator of associations between client report of the therapeutic bond and one-year outcomes of drinking frequency, drinking consequences, and psychiatric functioning. For analyses, the 1383 COMBINE trial participants were grouped as follows: 1) those receiving study medications (naltrexone, acamprosate, naltrexone + acamprosate, placebo) and enrolled in medication management (MM) only (n = 607), 2) those receiving study medications/MM and also enrolled in a combination behavioral intervention (CBI) as well (n = 619), and 3) those enrolled in CBI only (n = 157). Mediation analyses using the product-of-coefficients approach indicated self-efficacy change during treatment significantly mediated associations between the therapeutic bond with the CBI therapist and each of the three one-year outcomes among those exclusively receiving CBI, but failed to do so among those receiving pills/MM (with or without CBI). Effect sizes were small, but indicated that variance in bond-outcome associations was partially mediated by self-efficacy change for trial participants. Findings advance understanding of proximal client change processes during delivery of treatments for alcohol dependence.
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Affiliation(s)
- Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, 1107 NE 45th Street, Seattle, WA 98105, USA.
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Olive MF, Cleva RM, Kalivas PW, Malcolm RJ. Glutamatergic medications for the treatment of drug and behavioral addictions. Pharmacol Biochem Behav 2011; 100:801-10. [PMID: 21536062 DOI: 10.1016/j.pbb.2011.04.015] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/28/2011] [Accepted: 04/15/2011] [Indexed: 12/22/2022]
Abstract
Historically, most pharmacological approaches to the treatment of addictive disorders have utilized either substitution-based methods (i.e., nicotine replacement or opioid maintenance) or have targeted monoaminergic or endogenous opioidergic neurotransmitter systems. However, substantial evidence has accumulated indicating that ligands acting on glutamatergic transmission are also of potential utility in the treatment of drug addiction, as well as various behavioral addictions such as pathological gambling. The purpose of this review is to summarize the pharmacological mechanisms of action and general clinical efficacy of glutamatergic medications that are currently approved or are being investigated for approval for the treatment of addictive disorders. Medications with effects on glutamatergic transmission that will be discussed include acamprosate, N-acetylcysteine, d-cycloserine, gabapentin, lamotrigine, memantine, modafinil, and topiramate. We conclude that manipulation of glutamatergic neurotransmission is a relatively young but promising avenue for the development of improved therapeutic agents for the treatment of drug and behavioral addictions.
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Affiliation(s)
- M Foster Olive
- Department of Psychology, Arizona State University, Tempe, AZ 85287, USA.
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Witkiewitz K, Bowen S, Donovan DM. Moderating effects of a craving intervention on the relation between negative mood and heavy drinking following treatment for alcohol dependence. J Consult Clin Psychol 2011; 79:54-63. [PMID: 21261434 PMCID: PMC3157314 DOI: 10.1037/a0022282] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Negative affect is a significant predictor of alcohol relapse, and the relation between negative affect and drinking has been shown to be strongly mediated by alcohol craving. Thus, targeting craving during treatment could potentially attenuate the relation between negative affect and drinking. METHOD The current study is a secondary analysis of data from the COMBINE study, a randomized clinical trial that combined pharmacotherapy with behavioral intervention in the treatment of alcohol dependence. Our goal in the current study was to examine whether a treatment module that targeted craving would predict changes in negative mood during the 16-week combined behavioral intervention (n = 776) and the relation among changes in mood, craving, and changes in heavy drinking during treatment and 1 year posttreatment. RESULTS Changes in negative mood were significantly associated with changes in heavy drinking during treatment (f² = 0.78). Participants (n = 432) who received the craving module had significantly fewer heavy drinking days during treatment (d = 0.31), and receiving the module moderated the relation between negative mood and heavy drinking during treatment (f² = 0.92) and 1 year posttreatment (f² = 0.03). Moderating effects of the craving module were mediated by changes in craving during treatment. Within-subject analyses indicated significant pre- to postmodule reductions in negative mood. Additionally, postmodule craving significantly mediated the association between negative mood and heavy drinking during treatment and at posttreatment. CONCLUSIONS The craving module of the combined behavioral intervention may weaken the relation between negative affect and heavy drinking by fostering greater decreases in craving during treatment.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, Washington State University Vancouver, Vancouver, WA 98686, USA.
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Schuckit MA, Smith TL. Onset and course of alcoholism over 25 years in middle class men. Drug Alcohol Depend 2011; 113:21-8. [PMID: 20727682 PMCID: PMC3000869 DOI: 10.1016/j.drugalcdep.2010.06.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 05/21/2010] [Accepted: 06/21/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patterns of drinking and alcohol problems change with age. However, few studies use multiple data points and detailed history spanning early adulthood to middle age. This study reports such data from 373 men in the San Diego Prospective Study. METHODS Data were generated at baseline (T1) at ∼age 20, and through face-to-face followup interviews ∼every 5 years in >90% of these eligible Caucasian and relatively higher educated men. Subjects were placed into 4 groups regarding their course: 62.5% with no alcohol use disorder (AUD); 17.2% with AUD onset 5 years before the 25-year followup. RESULTS On a univariate level, low level of response (LR) to alcohol, family history of AUDs, and higher Novelty Seeking at ∼age 20 predicted AUDs with onset before age 30 (mean age∼25), but among these only LR predicted later onset (mean age 38) as well. Additional predictors of AUDs included demography (lower education), and greater involvement with alcohol, drugs, and nicotine prior to T1. Sustained remission from AUDs among alcoholics was predicted by lower T1 and T10 drinking frequencies, and being separated or divorced at T10, along with a trend for higher Reward Dependence. CONCLUSION These data indicate that information available in ages of the late teens to early twenties can help predict the future onset and course of AUDs, and underscore the importance of longitudinal studies in substance use disorders.
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Gunzerath L, Hewitt BG, Li TK, Warren KR. Alcohol research: past, present, and future. Ann N Y Acad Sci 2010; 1216:1-23. [PMID: 21182533 DOI: 10.1111/j.1749-6632.2010.05832.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Created forty years ago, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has played a major role in the great strides made in the understanding, treatment, prevention, and public acceptance of alcohol-use disorders. Throughout most of U.S. history "habitual drunkenness" was viewed as a problem of moral degeneracy or character flaw inherent in the individual. However, the wealth of scientific evidence amassed throughout NIAAA's history has established alcoholism as a medical condition, that is, as a disease for which affected individuals should feel no shame or be treated with disdain. We look at the developments in alcohol epidemiology, typology, etiology, prevention, and treatment research over the past 40 years. We also discuss how NIAAA addresses alcohol disorders from a life-course framework, affecting all stages of the lifespan, from fetus through child, adolescent, and young adult, to midlife/senior adult, with each stage involving different risks, consequences, prevention efforts, and treatment strategies.
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Affiliation(s)
- Lorraine Gunzerath
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland 20892, USA.
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