Is alcohol use associated with psychological treatment attendance and clinical outcomes?

Abstract

Objectives To investigate associations between alcohol use, psychological treatment attendance, and clinical outcomes. Methods We analysed electronic health records for N = 7,986 patients accessing psychological treatment for common mental disorders. Data were collected for pre‐treatment alcohol use (average units per week) and severity of dependence (SDS), number of therapy contacts attended, pre‐ and post‐treatment anxiety (GAD‐7), and depression (PHQ‐9) symptom severity. Hierarchical regression was used to examine associations between alcohol use/dependence and post‐treatment symptom severity controlling for intake severity and relevant confounders. Results After controlling for confounders, alcohol use had significant nonlinear associations with pre‐treatment depression severity (R2 = .54, p < .01, cubic trend), and post‐treatment anxiety (R2 = .23, p < .01, quadratic trend). Alcohol use was not significantly associated with intake anxiety, post‐treatment depression or treatment duration. SDS was not significantly associated with depression severity, alcohol severity, or total contacts after controlling for confounders. Conclusion Alcohol users are just as likely to engage in and benefit from evidence‐based psychological treatments for depression in primary care. A nonlinear association between alcohol use and anxiety treatment outcomes indicates that light‐to‐moderate drinkers have some shared characteristic that favours treatment response. Practitioner points Depression and anxiety problems often co‐occur with alcohol use and dependence. Conventional wisdom in the field suggests that heavy alcohol users may not engage well or benefit from psychological therapies for depression and anxiety. We found no empirical support for the above assumptions in a large clinical sample. Alcohol consumption was not significantly associated with treatment attendance or depression treatment outcomes. A nonlinear association between alcohol use and anxiety outcomes suggests that moderate drinkers may have some shared characteristic that favours treatment response.

Associations between alcohol use and outcome of psychological treatment in specialist psychiatric care – a cohort study

“…Consistently across all measures, patients with hazardous alcohol use at baseline showed the most improvements. Based on these results, we can conclude that patients with hazardous alcohol use achieve at least as good a therapeutic outcome on the symptom assessment instruments as patients without hazardous use, as shown in other studies ( Hunt and Delgadillo, 2022 ). This means that therapists, clinicians, and healthcare facilities need not hesitate to treat patients with hazardous alcohol use for anxiety and depression problems under the assumption that their alcohol consumption makes it difficult to benefit from psychologicaltreatment.…”

“…At follow-up, there was also no significant difference between the groups. Patients with hazardous alcohol use seem as likely to complete psychological treatment as other patients ( Hunt and Delgadillo, 2022 ) and they also seem to be at least as likely to answer questionnaires at completion and follow-up as other patients.…”

Engagement with engager: what factors are associated with attendance in a complex intervention for men with common mental health problems, near to and after release from prison

“…We did find that self-identifying as having an alcohol problem, the number of days drinking (in the month prior to entry into prison) and dependance were all indicative of better engagement with the Engager intervention. Research has suggested that alcohol users are just as likely to engage in and benefit from psychological therapy, in fact those with moderate alcohol use may gain more from therapy [19]. This may explain the increased attendance for this group in the Engager intervention, why we also saw that participants attending more sessions were receiving more therapeutic sessions and that we have defined this group as "crisis but coping".…”

“…This may explain the increased attendance for this group in the Engager intervention, why we also saw that participants attending more sessions were receiving more therapeutic sessions and that we have defined this group as "crisis but coping". It is postulated that moderate levels of alcohol use are linked to a capacity to tolerate distress and so these participants were able to tolerate more anxiety provoking situations and not rely on safety and avoidant behaviors [19], thus possibly explaining engagement.…”

“…Another frequent finding is that poorer attendance and engagement is associated with substance use [12,17,18] with the main focus being on illegal substance use. However, a recent study of psychological treatment attendance focusing just on alcohol use [19], looked at the electronic health records for 7986 patients accessing psychological treatment for common mental disorders. They found that alcohol consumption was not significantly associated with attendance and that moderate drinkers may have some shared characteristics which favor treatment response.…”