The BRENDA Model: Integrating Psychosocial Treatment and Pharmacotherapy for the Treatment of Alcohol Use Disorders

Starosta, Aron; Leeman, Robert F.; Volpicelli, Joseph R.

doi:10.1097/00131746-200603000-00003

Cited by 85 publications

(44 citation statements)

References 70 publications

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“…For example, Cochran (1984) and Peet and Harvey (1991) reported positive adherence outcomes after only 6 weeks of treatment focused solely on medication adherence. Similarly, positive results for treatment adherence have been obtained in studies using relatively low-intensity, yet targeted, interventions in other populations (e.g., the BRENDA model, see Starosta, Leeman, & Volpicelli, 2006). In contrast, longer duration interventions that only devoted a small fraction of time to medication adherence generated poorer adherence outcomes (Perry et al, 1999;Scott et al, 2006).…”

Section: Potentially Promising Strategies For Improving Bipolar Adhermentioning

confidence: 88%

“…NIH-PA Author Manuscript NIH-PA Author Manuscript using relatively low-intensity, yet targeted, interventions in other populations (e.g., the BRENDA model, see Starosta, Leeman, & Volpicelli, 2006). In contrast, longer duration interventions that only devoted a small fraction of time to medication adherence generated poorer adherence outcomes (Perry et al, 1999;Scott et al, 2006).…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

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Improving Treatment Adherence in Bipolar Disorder

2008

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Treatment adherence is a frequent problem in bipolar disorder, with research showing that upwards of 60% of bipolar patients are at least partially nonadherent to medications. Treatment nonadherence is consistently predictive of a number of negative outcomes in bipolar samples, and the discontinuation of mood stabilizers places these patients at high risk for relapse. Several types of adjunctive treatment (family, psychoeducational, cognitive-behavioral) have been investigated for improving symptoms and functioning in bipolar patients with some success. To date, less attention has been paid to developing treatments specifically to promote treatment adherence to and engagement with pharmacological as well as behavioral treatments in patients with bipolar disorder. First, we review the effects of adjunctive interventions specifically on treatment adherence outcomes in 14 published clinical trials. Based on this empirical knowledgebase, we present a preliminary description of the treatment strategies that appear most promising for improving adherence. We also provide research recommendations for developing more effective interventions for the purpose of improving bipolar treatment adherence. Special treatment considerations, including the potential impact of comorbid substance abuse and bipolar depression, are discussed. Keywords bipolar disorder; adherence; psychosocial treatments; mood stabilizers; clinical trials; bipolar depression; substance use disorders Bipolar disorder is typically a chronic and severe mental illness present in 1-2% of the general population (Kessler et al., 1994;Regier et al., 1988). If diagnoses of bipolar II disorder are included in estimates, the prevalence increases to 3.9% (Kessler, Chiu, Demler, Merikangas, & Walters, 2005). Bipolar disorder is reported to be the 6 th leading cause of disability worldwide in those ages 15-44 (Murray & Lopez, 1996), and recent estimates suggest that medication and treatment costs for bipolar patients exceed $17,000 per individual annually (Stender, Bryant-Comstock, & Phillips, 2002). The societal and personal burdens of bipolar disorder are due in part to its typically impairing course of illness. Over 70% of bipolar patients experience at least one recurrence within 4 years of the index episode (Gitlin, Swendsen, Heller, & Hammen, 1995). Judd et al. (2002) studied the symptomatic course in bipolar I patients for an average of 13 years, and reported that individuals spent 32% of the time with clinically significant depression symptoms, 9% with Address correspondence to: Brandon A. Gaudiano, Butler Hospital, Psychosocial Research Program, 345 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript manic symptoms, and 6% with mixed symptoms. Unfortunately, these high rates of relapse, symptomatic illness, and impairment are frequently reported even in bipolar samples receiving maintenance pharmacotherapy (Gitlin et al., 1995;Harrow, Goldberg, Grossman, & Meltzer, 1990;Miller, Uebelacker, Keitner, Ryan, & Solomon, 2004).A Wor...

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Section: Potentially Promising Strategies For Improving Bipolar Adhermentioning

confidence: 88%

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Improving Treatment Adherence in Bipolar Disorder

2008

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“…Patients were instructed to take one tablet on each day they perceived a risk of drinking alcohol (‘as-needed dosing'), preferably 1-2 h prior to the anticipated time of drinking, but otherwise as soon after drinking had started. In addition, all patients took part in a low-intensity motivational and adherence-enhancing intervention (BRENDA) [13] starting at randomisation and subsequently at all scheduled visits. No treatment goal was defined, i.e.…”

Section: Methodsmentioning

confidence: 99%

Clinical Relevance of As-Needed Treatment with Nalmefene in Alcohol-Dependent Patients

Aubin¹,

Reimer²,

Nutt³

et al. 2015

Eur Addict Res

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Nalmefene is the first drug approved for reduction of alcohol consumption. The aim of this study was to evaluate the clinical relevance of treatment with nalmefene in alcohol-dependent patients with a high drinking risk level from two randomised placebo-controlled 6-month studies (NCT00811720 and NCT00812461). Response criteria were based on alcohol consumption, Clinical Global Impression, and Short Form Health Survey mental component summary scores at month 6, analysed using logistic regression. The proportion of responders was higher in the nalmefene group than in the placebo group with odds ratios significantly in favour of nalmefene for all responder criteria; numbers-needed-to-treat ranged from 6 to 10. Significant differences from placebo in clinician-rated and patient-reported outcomes, and liver enzymes further supported the clinical relevance of the treatment effect. In conclusion, this study supports the clinical relevance of nalmefene treatment in patients with alcohol dependence. Nalmefene may help to reduce the alcohol-related burden and the large treatment gap, with currently less than 10% of alcohol-dependent patients in Europe receiving treatment.

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“…From randomisation onwards, all patients took part in a regular motivational and adherence-enhancing intervention (BRENDA [32]).…”

Section: Methodsmentioning

confidence: 99%

Can Alcohol Dependent Patients Adhere to an ‘As-Needed' Medication Regimen?

et al. 2014

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A pooled analysis of ‘as-needed medication use' data from 1,276 patients in two randomised, double-blind, placebo-controlled, parallel-group trials of nalmefene in the treatment of alcohol dependence was performed to explore whether an ‘as-needed' regimen is an acceptable and feasible strategy in patients seeking help for alcohol dependence. Adherence was defined as alcohol consumption and medication intake, or no alcohol consumption (with or without medication intake). Nalmefene was taken on approximately half of the study days; placebo was taken more often than nalmefene (52.8 vs. 64.5% of days, respectively). In each treatment group medication intake appeared to vary according to patients' needs in that intake correlated with the baseline drinking pattern. Sixty-eight percent of the nalmefene-treated patients (78% of the study completers) adhered to the as-needed treatment regimen on at least 80% of the study days. In conclusion, as-needed use is a feasible, patient-centred approach that engages patients with alcohol dependence in the active management of their illness.

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The BRENDA Model: Integrating Psychosocial Treatment and Pharmacotherapy for the Treatment of Alcohol Use Disorders

Cited by 85 publications

References 70 publications

Improving Treatment Adherence in Bipolar Disorder

Improving Treatment Adherence in Bipolar Disorder

Clinical Relevance of As-Needed Treatment with Nalmefene in Alcohol-Dependent Patients

Can Alcohol Dependent Patients Adhere to an ‘As-Needed' Medication Regimen?

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