The Place of Additional Individual Psychotherapy in the Treatment of Alcoholism: A Randomized Controlled Study in Nonresponders to Anticraving Medication—Results of the <scp>PREDICT</scp> Study

Berner, Michael; Wahl, Sonja; Brueck, Rigo; Frick, Katrin; Smolka, Robert; Haug, Monika; Hoffmann, Sabine; Reinhard, Iris; Leménager, Tagrid; Gann, Horst; Batra, Anil; Mann, Karl

doi:10.1111/acer.12317

Cited by 16 publications

(7 citation statements)

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“…Seventy subjects (5.74%) were coded as heavy drinking due to missing values. In PREDICT once subjects relapsed to heavy drinking they were switched to another protocol (Berner et al, 2013); therefore, the outcome variable in PREDICT was whether subjects relapsed to heavy drinking during double-blind treatment.…”

Section: Methodsmentioning

confidence: 99%

Predictors of Abstinence from Heavy Drinking During Treatment in COMBINE and External Validation in PREDICT

Gueorguieva

O’Connor

et al. 2014

Alcoholism Clin & Exp Res

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Background The goal of the current study was to use tree-based methods (Zhang and Singer, 2010) to identify predictors of abstinence from heavy drinking in COMBINE (Anton et al., 2006), the largest study of pharmacotherapy for alcoholism in the United States to date, and to validate these results in PREDICT (Mann et al., 2012), a parallel study conducted in Germany. Methods We compared a classification tree constructed according to purely statistical criteria to a tree constructed according to a combination of statistical criteria and clinical considerations for prediction of no heavy drinking during treatment in COMBINE. We considered over one-hundred baseline predictors. The tree approach was compared to logistic regression. The trees and a deterministic forest identified the most important predictors of no heavy drinking for direct testing in PREDICT. Results The tree built using both clinical and statistical considerations consisted of four splits based on consecutive days of abstinence (CDA) prior to randomization, age, family history of alcoholism (FHAlc) and confidence to resist drinking in response to withdrawal and urges. The tree based on statistical considerations with four splits also split on CDA and age but also on GGT level and drinking goal. Deterministic forest identified CDA, age and drinking goal as the most important predictors. Backward elimination logistic regression among the top 18 predictors identified in the deterministic forest analyses identified only age and CDA as significant main effects. Longer CDA and goal of complete abstinence were associated with better outcomes in both data sets. Conclusions The most reliable predictors of abstinence from heavy drinking were CDA and drinking goal. Trees provide binary decision rules and straightforward graphical representations for identification of subgroups based on response and may be easier to implement in clinical settings.

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Section: Methodsmentioning

confidence: 99%

Predictors of Abstinence from Heavy Drinking During Treatment in COMBINE and External Validation in PREDICT

Gueorguieva

O’Connor

et al. 2014

Alcoholism Clin & Exp Res

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“…Eine Medikamenteneinnahme weist zusätzlich zur reinen Substanzwirkung einen größeren Placeboeffekt auf als ein reines Gespräch. Ein additiver Effekt von Psychotherapie und medikamentöser Rückfallprophylaxe wurde bereits in einer anderen Studie berichtet [27]. Potentielle psychologische Mechanismen, die eine höhere Wirksamkeit einer supervidierten Einnahme bedingen, wurden zwar nicht im Detail untersucht, sollen aber dennoch kurz dargestellt werden, da sie in der Praxis breit angewendet werden können.…”

Section: Soziobiografische Variablenunclassified

Verbessert eine intensivierte ambulante Behandlung das Outcome von schwer alkoholabhängigen Patienten? Eine Pilotstudie

et al. 2016

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Zusammenfassung Ziel der Studie: Disulfiram ist zur Senkung der R?ckfallrate bei Alkoholabh?ngigen nur wirksam, wenn es mit mehrmals w?chentlichen Kontakten verkn?pft ist. Es stellt sich daher die Frage, ob eine intensivierte ambulante Behandlung auch ohne Disulfiram wirkt, bzw. ob es bestimmte Patientengruppen gibt, die von einer solchen Therapie profitieren. Methodik: In einer nicht-randomisierten Verlaufsbeobachtung konnten sich Alkoholabh?ngige nach abgeschlossener station?rer Entzugsbehandlung f?r die intensivierte Behandlung (IB, 3x/Woche ?rztliche Kurzkontakte) oder die regul?re Behandlung (RB, 1 ?rztlicher Kontakt alle 2 Wochen) entscheiden. Zur regul?ren Behandlung geh?rt das Angebot einer r?ckfallprophylaktischen Medikation mit Naltrexon: dies wurde auch bei IB angeboten. Bei Einschluss wurden Alkoholkonsum und -verlangen, soziobiografische Daten, Vorbehandlungen und ?ngstlichkeit erfasst. Anschlie?end wurde ?ber 3 Monate das Konsummuster erhoben. Ergebnisse: 75 Patienten (41 RB, 34 IB) wurden eingeschlossen. Patienten in IB waren h?ufiger Frauen und wiesen mehr Vorbehandlungen, eine schwerere Abh?ngigkeit und st?rkere ?ngstlichkeit auf. Die Konsummengen nahmen bis zum Endpunkt der Studie nach 3 Monaten in beiden Gruppen signifikant ab, ohne Unterschiede zwischen den einzelnen Gruppen. Schlussfolgerung: Der neue Therapieansatz IB ist durchf?hrbar, erg?nzt die bisherigen Behandlungsm?glichkeiten und scheint hilfreich zu sein f?r schwer Alkoholabh?ngige (vor allem Frauen), f?r die eine Behandlung mit Disulfiram nicht in Frage kommt.

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“…Cognitive-behavioural therapies, motivational enhancement interviewing and brief interventions in particular are established and frequently used therapies with low to moderate effect sizes [21,22]; other therapies include contingency management, 12-step therapies, relapse prevention, family therapy and case management [18,20,[23][24][25]. Psychotherapy is also effective in patients treated with so-called anticraving drugs [26]. However, relapse to heavy drinking is very common after conventional alcohol therapies and abstinence rates rarely exceed 40 % [1].…”

Section: Existing Treatment ▼mentioning

confidence: 99%

Recent Developments in Pharmacotherapy of Alcoholism

Soyka

Lieb

2015

Pharmacopsychiatry

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The Place of Additional Individual Psychotherapy in the Treatment of Alcoholism: A Randomized Controlled Study in Nonresponders to Anticraving Medication—Results of the PREDICT Study

Abstract: Our data indicate that patients that are willing to attend psychotherapy benefit from receiving psychotherapy in addition to pharmacotherapy. We suggest that it may be beneficial to consider patients' preferences concerning psychotherapy at an earlier stage during treatment.

Cited by 16 publications

References 26 publications

Predictors of Abstinence from Heavy Drinking During Treatment in COMBINE and External Validation in PREDICT

Predictors of Abstinence from Heavy Drinking During Treatment in COMBINE and External Validation in PREDICT

Verbessert eine intensivierte ambulante Behandlung das Outcome von schwer alkoholabhängigen Patienten? Eine Pilotstudie

Recent Developments in Pharmacotherapy of Alcoholism

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