Alcohol Dependence: Analysis of Factors Associated with Retention of Patients in Outpatient Treatment

Elbreder, Márcia Fonsi; Silva, Rebeca de Souza e; Pillon, Sandra Cristina; Laranjeira, Ronaldo

doi:10.1093/alcalc/agq078

Cited by 28 publications

(26 citation statements)

References 12 publications

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“…Demographic factors that may be related to attrition and treatment dropout include membership in a minority group, unemployment, younger age, and male gender (see Palmer et al, 2009 for a review). Client factors, such as lower motivation to change, lower severity of problems, mental health comorbidity, and poor social support have all been shown to predict higher rates of attrition and treatment dropout (Elbreder et al, 2011; McKeller et al, 2006; Palmer et al, 2009; Tull and Gratz, 2012). Program factors, such as more controlling environments and greater barriers to treatment engagement have been shown to predict treatment dropout (McKellar et al, 2006; Palmer et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Methods to Analyze Treatment Effects in the Presence of Missing Data for a Continuous Heavy Drinking Outcome Measure When Participants Drop Out from Treatment in Alcohol Clinical Trials

Witkiewitz

Falk

Kranzler

et al. 2014

Alcoholism Clin & Exp Res

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Background Attrition is common in alcohol clinical trials and the resultant loss of data represents an important methodological problem. In the absence of a simulation study, the drinking outcomes among those who are lost to follow-up are not known. Individuals who drop out of treatment and continue to provide drinking data, however, may be a reasonable proxy group for making inferences about the drinking outcomes of those lost to follow-up. Methods We used data from the COMBINE study, a multisite, randomized clinical trial, to examine drinking during the four months of treatment among individuals who dropped out of treatment but continued to provide drinking data (i.e., “treatment dropouts;” n=185). First, we estimated the observed treatment effect size for naltrexone versus placebo in a sample that included both treatment completers (n=961) and treatment dropouts (n=185; total N=1146), as well as the observed treatment effect size among just those who dropped out of treatment (n=185). In both the total sample (N=1146) and the dropout sample (n=185), we then deleted the drinking data after treatment dropout from those 185 individuals to simulate missing data. Using the deleted datasets we then estimated the effect of naltrexone on the continuous outcome percent heavy drinking days using six methods to handle missing data (last observation carried forward, baseline observation carried forward, placebo mean imputation, missing=heavy drinking days, multiple imputation (MI), and full information maximum likelihood (FIML)). Results MI and FIML produced effect size estimates that were most similar to the true effects observed in the full data set in all analyses, while missing=heavy drinking days performed the worst. Conclusions Although missing drinking data should be avoided whenever possible, MI and FIML yield the best estimates of the treatment effect for a continuous outcome measure of heavy drinking when there is dropout in an alcohol clinical trial.

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Section: Introductionmentioning

confidence: 99%

Methods to Analyze Treatment Effects in the Presence of Missing Data for a Continuous Heavy Drinking Outcome Measure When Participants Drop Out from Treatment in Alcohol Clinical Trials

Witkiewitz

Falk

Kranzler

et al. 2014

Alcoholism Clin & Exp Res

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“…Despite the advances in pharmacology and increased knowledge of the pathophysiology of substance dependence, treatment remains a challenge (Elbreder, Silva, Pillon, & Laranjeira, 2011). Substance dependence treatment requires, in addition to psychotropic drugs, a multidisciplinary team providing therapies with a psychosocial approach, such as individual and group psychotherapy, family support groups, occupational therapy, and rehabilitation for reentry into the labor market (Marques & Ranieri, 2011).…”

mentioning

confidence: 99%

Quality of Life Determinants in Patients of a Psychosocial Care Center for Alcohol and other Drug Users

Marini

Schnornberger

Brandalise

et al. 2013

Issues in Mental Health Nursing

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Quality of life assessments in patients receiving treatment for substance dependence can serve as one predictor of response to treatment. This study aimed to identify determinants of quality of life in patients of a Psychosocial Care Center for alcohol and other drug users (CAPSad). The sample consisted of 77 patients with a diagnosis of substance dependence being treated at CAPSad for more than six months. Severity of substance dependence was assessed using the Addiction Severity Index (ASI-6), quality of life was assessed using the World Health Organization Quality of Life assessment instrument-short version (WHOQOL-BREF), and depressive symptoms were assessed by the Beck Depression Inventory (BDI). Data on CAPSad activities, psychiatric diagnoses, and medications used were collected from the medical records. Quality of life was significantly impaired in more severe cases of substance dependence and in those with more severe depressive symptoms. As for other variables, poorer quality of life was significantly associated with a greater number of years of education, unemployment, use of medications, and greater use of individual sessions with the reference professional. Linear regression analysis revealed depressive symptom severity to be an independent determinant of quality of life impairment, accounting for over 50% of the variation in physical and psychological domains. These results demonstrate the need to consider other factors, such as depressive symptoms and quality of life, in the treatment of substance dependence.

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“…Analisando o tipo de estudo, sete artigos descrevem ensaios clí-nicos [5][6][7][8][9][10][11] , um trata-se de um relato de caso 12 e o artigo restante é uma revisão bibliográfica 13 . A realização de busca equivalente na base LILACS não resultou na identificação de outros artigos com estudos semelhantes que pudessem ser incluídos nesta lista.…”

Section: Resultados E Discussão Panorama Geral Das Publicações Brasilunclassified

“…Destes, três conduziram ensaios clínicos (GREA 7,8,10,11 , UNIAD 5,6 e UFES 9 ). O quarto grupo (PROJAD) publicou um relato de caso 12 .…”

Section: Resultados E Discussão Panorama Geral Das Publicações Brasilunclassified

“…Pesquisadores do UNIAD realizaram estudo transversal de mais 800 pacientes no período 2000-2006 sobre o uso do dissulfiram que originou duas publicações 5,6 . O estudo demonstrou que os pacientes que permaneceram em tratamento durante o primeiro ano completo usaram proporcionalmente mais dissulfiram do que aqueles que permaneceram por período de tratamento mais curto.…”

Section: Dissulfiramunclassified

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Contribuição de grupos de pesquisa brasileiros na avaliação de fármacos para o tratamento da dependência de álcool

Almeida

Souto

2012

Arq. Bras. Ciên. Saúde

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RESUMOEstatísticas recentes mostram que milhões de brasileiros apresentam dependência de álcool. Uma das principais estratégias para o tratamento desses dependentes é a terapia farmacológica, que ainda apresenta baixas taxas de sucesso. Nesse contexto, é de suma importância que grupos de pesquisa nacionais conduzam estudos de avaliação de fármacos para o tratamento de dependentes de álcool. Este estudo é uma revisão bibliográfica narrativa crítica realizada na base de dados MEDLINE que teve por objetivo identificar os grupos de pesquisa brasileiros interessados no tratamento farmacológico do alcoolismo. Foi realizada busca de todos os artigos publicados a partir de 1996 com a seguinte combinação de termos: alcoholism, drug therapy, humans e Brazil. Nove artigos foram localizados, sendo sete ensaios clínicos, uma revisão e um relato de caso. Esses estudos foram conduzidos em quatro instituições diferentes, sendo que uma foi responsável por mais da metade dos artigos. Considerando as publicações no MEDLINE sobre quimioterapia do alcoolismo em humanos, esses artigos representariam 0,71% da produção científica mundial no mesmo período. Os estudos envolvem cinco fármacos, sendo três aprovados para tratamento do alcoolismo -dissulfiram, naltrexona e acamprosato; e dois em avaliação -topiramato e gabapentina. Conclui-se que os pesquisadores brasileiros estão contribuindo efetivamente para a análise do arsenal terapêutico do tratamento do alcoolismo, assim como sua expansão com novos fármacos. Entretanto, o número de grupos de pesquisa nacionais interessados por esta questão ainda é muito pequeno para a extensão do problema no País.Palavras-chave: alcoolismo/quimioterapia; ensaio clínico; Brasil. ABSTRACTRecent statistics show that millions of Brazilians are alcohol dependents. One of the main strategies for the treatment of such dependents is pharmacological therapy, which presents low success rate. In such context, it is essential that national research groups lead analyses of existing and new drugs for the treatment of alcohol dependents. This study is a narrative and critical bibliographic review of MEDLINE database aiming to identify Brazilian research groups interested in pharmacological treatment of alcoholism. A search of all articles published since 1996 was performed with the following combinations of terms: alcoholism, drug therapy, humans and Brazil. Nine articles were found, including seven clinical trials, one review and one case report. Such studies were conducted by four distinct institutions, one of them being responsible for more than half of the papers. Considering MEDLINE publications on drug therapy of alcoholism in humans, these papers represent 0.71% of the worldwide scientific production during the same period. The studies comprise five substances, three approved for alcoholism treatment -disulfiram, naltrexone, and acamprosate; -and two under evaluation -topiramate and gabapentin. It is concluded that Brazilian scientists are effectively contributing to the analysis of the therapeutical arsenal ...

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Alcohol Dependence: Analysis of Factors Associated with Retention of Patients in Outpatient Treatment

Abstract: Such results suggest possibilities for developing specific strategies to reduce the risk of early dropout from treatment.

Cited by 28 publications

References 12 publications

Methods to Analyze Treatment Effects in the Presence of Missing Data for a Continuous Heavy Drinking Outcome Measure When Participants Drop Out from Treatment in Alcohol Clinical Trials

Methods to Analyze Treatment Effects in the Presence of Missing Data for a Continuous Heavy Drinking Outcome Measure When Participants Drop Out from Treatment in Alcohol Clinical Trials

Quality of Life Determinants in Patients of a Psychosocial Care Center for Alcohol and other Drug Users

Contribuição de grupos de pesquisa brasileiros na avaliação de fármacos para o tratamento da dependência de álcool

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