Alcohol dependence severity determines the course of treatment‐seeking patients

Yoshimura, Atsushi; Kimura, Masashi; Matsushita, Satoru; Yoneda, Junichi; Maesato, Hitoshi; Komoto, Yoshiaki; Nakayama, Hideki; Sakuma, Hiroshi; Yumoto, Yosuke; Takimura, Tsuyoshi; Tohyama, Tomomi; Iwahara, Chie; Mizukami, Takeshi; Yokoyama, Akira; Higuchi, Susumu

doi:10.1111/acer.14707

Cited by 6 publications

(8 citation statements)

References 39 publications

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“…The subjects were thought to be representative of patients with relatively severe alcohol dependence [ 56 ]. Actually, the severities of the subjects were confirmed using the number of ICD-10 criteria that were met [ 21 ]. Third, the present study targeted patients who had undergone an intensive 10-week inpatient program.…”

Section: Discussionmentioning

confidence: 99%

“…Some patients were excluded because they had insufficient cognitive functions, refused to continue participating in the study during the treatment process, or did not attend the alcohol treatment program. Of these, 637 patients (543 males, 94 females) were qualified to participate in the study [ 21 ]. All the patients underwent the standard 10-week alcohol treatment program while in the hospital.…”

Section: Methodsmentioning

confidence: 99%

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Influence of ADHD, especially attention-deficit characteristics, on the course of alcohol-dependent individuals

et al. 2022

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Background While several studies have revealed that neurodevelopmental disorders have a high probability of overlapping with substance use disorders, the effects of neurodevelopmental disorders on the courses of substance use disorders have hardly been examined. Methods This study targeted 637 alcohol-dependent individuals who received inpatient treatment and whose drinking situations were followed for 12 months after hospital discharge using mailed questionnaires. The comorbidity of psychiatric disorders and the characteristics associated with the neurodevelopmental disorders were assessed using several measurements at the time of hospital admission. The effects of neurodevelopmental disorders on the drinking courses of the subjects were then estimated. Results The presence of a current depressive episode or any anxiety disorder significantly lowered the abstinence rates during the follow-up period (p = 0.0195 and p = 0.0214, respectively). ADHD traits as assessed using the ADHD Self-report Scale (ASRS) predicted a significantly poorer abstinence rate (p = 0.0296). Similarly, attention-deficit characteristics assessed objectively through interviews predicted a significantly lower abstinence rate (p = 0.0346), and a sensitivity analysis enhanced these results (p = 0.0019). When the drinking patterns were classified into three groups, the subjects with attention-deficit characteristics had a significantly higher rate of “Recurrence” and lower rates of “Abstinence” and “Controlled drinking” (p = 0.013). In a multivariate proportional hazards analysis, the ASRS score was significantly correlated with the re-drinking risk (p = 0.003). Conclusion ADHD traits had significant effects on not only abstinence rates, but also on drinking pattern. The presence of ADHD traits, especially attention-deficit characteristics, influenced the drinking courses of alcohol-dependent individuals after hospital treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Influence of ADHD, especially attention-deficit characteristics, on the course of alcohol-dependent individuals

et al. 2022

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“…In tree‐based and logistic regression analyses of the COMBINE Study, considering the same predictors, and PREDICT, a smaller trial among AUD patients from inpatient facilities randomly assigned to naltrexone, acamprosate, or placebo, drinking goal and Alcohol Dependence Scale score emerged as important predictors (Gueorguieva et al, 2014). Since we also identified total Alcohol Dependence Scale score as a potentially important splitting variable for no heavy drinking days, assessing total Alcohol Dependence Scale score and drinking goals of trial participants at the beginning of trials could potentially help identify the most appropriate interventions to achieve the outcomes desired by patients (e.g., abstinence vs. drinking reduction outcomes; O'Malley et al, 2015; Yoshimura et al, 2021). Although these characteristics may have value in matching individuals to treatment in research and clinical practice, this would need to be formally evaluated.…”

Section: Discussionmentioning

confidence: 99%

Predictors of abstinence, no heavy drinking days, and a 2‐level reduction in World Health Organization drinking levels during treatment for alcohol use disorder in the COMBINE study

Wallach¹,

Gueorguieva

Phan

et al. 2022

Alcoholism Clin & Exp Res

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Background Data from trials of medications for alcohol use disorder (AUD) can be used to identify predictors of drinking outcomes regardless of treatment, which can inform the design of future trials with heterogeneous populations. Here, we identified predictors of abstinence, no heavy drinking days, and a 2‐level reduction in World Health Organization (WHO) drinking levels during treatment for AUD in the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study. Methods We utilized data from the COMBINE Study, a randomized placebo‐controlled trial evaluating the efficacy of naltrexone and acamprosate, both alone and in combination, for AUD (n = 1168). A tree‐based machine learning algorithm was used to construct classification trees predicting abstinence, no heavy drinking days, and a 2‐level reduction in WHO drinking levels in the last 4 weeks of treatment, based on 89 baseline variables. Results The final tree for predicting abstinence had one split based on consecutive days abstinent prior to randomization, with a higher proportion of subjects achieving abstinence among those classified as abstinent for >2 versus ≤2 consecutive weeks prior to randomization (66% vs. 29%). The final tree for predicting no heavy drinking days in the last 4 weeks of treatment had three splits based on consecutive days abstinent, age, and total Alcohol Dependence Scale score at baseline. Seventy‐three percent of the subjects classified as abstinent for >2 consecutive weeks prior to randomization had no heavy drinking days in the last 4 weeks of treatment. Among those classified as abstinent ≤2 consecutive weeks prior, three additional splits showed that younger subjects (age ≤44 years; 37%), and older subjects (age >44) with a total Alcohol Dependence Scale score >13 and complete abstinence (56%) or other drinking goals (35%), were less likely to have no heavy drinking days than older subjects with a total Alcohol Dependence Scale score ≤13 (67%). The final tree for predicting a 2‐level reduction in WHO levels had no splits. Conclusions Consecutive days abstinent prior to randomization may predict abstinence and no heavy drinking days and total Alcohol Dependence Scale score and age may predict no heavy drinking days. The 2‐level reduction in WHO levels outcome may be less likely to discriminate based on multiple patient characteristics.

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“…This study was designed as part of a prospective drinking outcome study [ 10 ] in patients who had been admitted to the Center for the treatment of alcohol dependence between January and December 2014. Five hundred and forty-three men (20–85 years old) were admitted for the treatment of alcohol dependence during the study period and provided written informed consent to participate in the original prospective study.…”

Section: Methodsmentioning

confidence: 99%

“…Excluding subjects who had participated in the ARP on two or more occasions, 242 subjects participated in the ARP for the first time. Since the prognosis for sobriety was very poor for the patients in multiple inpatient treatment [ 10 ], only first-time treatment patients were included in the present study. Mailed questionnaires could not be sent to 8 subjects after hospital discharge because of an unknown address or death within a month after discharge.…”

Section: Methodsmentioning

confidence: 99%

Nonsmoking after simultaneous alcohol abstinence and smoking cessation program was associated with better drinking status outcome in Japanese alcohol-dependent men: A prospective follow-up study

et al. 2023

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Background Growing evidence suggests that intervention for smoking cessation enhances alcohol abstinence in treatment settings for alcohol dependence. However, research in this field is rare in Asians. Method We prospectively investigated the association of smoking status with drinking status using 9 surveys mailed during a 12-month period in 198 Japanese alcohol-dependent men (70 never/ex-smokers and 128 smokers) who admitted for the first time and completed a 3-month inpatient program for simultaneous alcohol abstinence and smoking cessation. Results Nonsmoking during the first month after discharge and at the end of follow-up was reported in 28.9% and 25.0% of the baseline smokers, respectively. Kaplan-Meier estimates showed that a 12-month alcohol abstinence and heavy-drinking-free status were more frequent among never/ex-smokers (45.1% and 59.8%, respectively) and baseline smokers who quit smoking during the first month after discharge (59.0% and 60.8%, respectively), compared with sustained smokers (30.0% and 41.2%, respectively). Among the baseline smokers, the multivariate odds ratio (95% confidence interval) for smoking cessation during the first month were 2.77 (1.01–7.61) for alcohol abstinence during the period and 2.50 (1.00–6.25) for use of varenicline, a smoking cessation agent, during the inpatient program. After adjusting for age, drinking profile, lifestyle, family history of heavy or problem drinking, lifetime episodes of other major psychiatric disorders, and medications at discharge, the multivariate hazard ratios (HRs) for drinking lapse were 0.57 (0.37–0.89) for the never/ex-smoking and 0.41 (0.23–0.75) for new smoking cessation groups, respectively, compared with sustained smoking, while the corresponding HRs for heavy-drinking lapse were 0.55 (0.33–0.90) and 0.47 (0.25–0.88), respectively. The HR for drinking lapse was 0.63 (0.42–0.95) for the nonsmoking group (vs. smoking) during the observation period, while the HR for heavy-drinking lapse was 0.58 (0.37–0.91) for the nonsmoking group (vs. smoking) during the observation period. Other significant variables that worsened drinking outcomes were higher daily alcohol intake prior to hospitalization, family history of heavy or problem drinking and psychiatric medications at discharge. Conclusion Nonsmoking was associated with better outcomes on the drinking status of Japanese alcohol-dependent men, and a smoking cessation program may be recommended to be integrated into alcohol abstinence programs.

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Alcohol dependence severity determines the course of treatment‐seeking patients

Cited by 6 publications

References 39 publications

Influence of ADHD, especially attention-deficit characteristics, on the course of alcohol-dependent individuals

Influence of ADHD, especially attention-deficit characteristics, on the course of alcohol-dependent individuals

Predictors of abstinence, no heavy drinking days, and a 2‐level reduction in World Health Organization drinking levels during treatment for alcohol use disorder in the COMBINE study

Nonsmoking after simultaneous alcohol abstinence and smoking cessation program was associated with better drinking status outcome in Japanese alcohol-dependent men: A prospective follow-up study

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