The Impact of Alcohol Use on Drop-out and Psychological Treatment Outcomes in Improving Access to Psychological Therapies Services: an Audit

Abstract

IAPT services may be well placed to offer psychological therapies to patients with common mental disorders and comorbid AUD. Patients with AUD can have equivalent treatment outcomes to those without AUD, but some higher risk drinkers may find accessing IAPT treatment more difficult as they are more likely to drop out. Alcohol misuse on its own should not be used as an exclusion criterion from IAPT services. Recommendations are given as to how clinicians can: adjust their assessments to consider the appropriateness of IAPT treatment for patients that misuse alcohol, consider the potential impact of alcohol misuse on treatment, and improve engagement in treatment for higher risk drinkers.

More sensitive identification of psychotic experiences in common mental disorder by primary mental healthcare services – effect on prevalence and recovery: casting the net wider

“…Although commissioned to treat mild to moderate CMD, IAPT services serve a clinical population with increasingly complex and comorbid conditions. [10][11][12][13] As psychotic experiences emerge in more severe cases of CMD, 1 we hypothesised in recent work that a proportion of the IAPT population would experience psychotic phenomena and, given the lack of specific treatment protocols for addressing psychotic experiences, we also predicted that this group would have poorer treatment outcomes. 14 Using a cut-off score of 1.47 on the 15-item Community Assessment of Psychic Experiences-Positive (CAPE-P15) scale, 15 a score previously calibrated 16 against the Comprehensive Assessment of At-Risk Mental States (CAARMS), 17 which identifies individuals with at-risk mental states for psychosis, we identified psychotic experiences in 30% of the IAPT case-load.…”

Latent variable mixture modelling and individual treatment prediction

“…The latent profiles are generated using nine patient level characteristics that are collected as part of the IAPT minimum dataset (MDS) and are therefore available to all local IAPT services, and these are presented in Table 1 . Several studies have reported on a number of other factors that might help give more accurate predictions of treatment outcomes in IAPT, for example expectancy of benefit with treatment ( Delgadillo, Moreea, & Lutz, 2016 ) and attentional control ( Buckman, Naismith, et al, 2018 ) are related to symptomatic improvement in treatment, and alcohol misuse was associated with treatment attrition ( Buckman, Naismith, et al, 2018 ). However, as these are not routinely used in all IAPT services they were not available for the present analyses.…”

What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database

“…For those that do get treatment the majority will either not reach remission or it will take a number of trials of different treatments before they do (Kessler, 2018;Rush et al, 2006). Not reaching full remission is one of the strongest predictors of relapse and recurrence (Buckman et al, 2018). There is a lack of knowledge of prognosis independent of treatment and within different types of treatment, and therefore a lack of evidence with which to make informed choices of whether any active treatment should be trialled, or which type of treatment to trial at any given point, for any given individual (e.g.…”

“…Weaver et al, 2003). Some studies have suggested that alcohol misuse (excluding alcohol dependence) is a prognostic indicator of treatment outcomes for those with depression (Clarkson et al, 2016), but others have suggested that it is unrelated to treatment outcomes (Boschloo et al, 2012) and instead is predictive only of dropping out of treatment (Buckman et al, 2018). There are several other factors that may be related to depression treatment outcomes but again, the effects have been less well studied.…”