AIM: To test whether addition of moderation-orientated cue exposure (CE) or CE after dysphoric mood induction (emotional CE, ECE) improved outcomes above those from cognitive-behaviour therapy alone (CBT) in people who drank when dysphoric. DESIGN: Multi-site randomized controlled trial comparing CBT with CBT + CE and CBT + ECE. SETTING: Out-patient rooms in academic treatment units in Brisbane and Sydney, Australia. PARTICIPANTS: People with alcohol misuse and problems controlling consumption when dysphoric (n = 163). Those with current major depressive episode were excluded. INTERVENTION: Eight weekly 75-minute sessions of individual treatment for alcohol problems were given to all participants, with CBT elements held constant across conditions. From session 2, CBT + CE participants resisted drinking while exposed to alcohol cues, with two priming doses of their preferred beverage being given in some sessions. After an initial CE session, CBT + ECE participants recalled negative experiences before undertaking CE, to provide exposure to emotional cues of personal relevance. MEASUREMENTS: Alcohol consumption, related problems, alcohol expectancies, self-efficacy and depression. RESULTS: Average improvements were highly significant across conditions, with acceptable maintenance of effects over 12 months. Both treatment retention and effects on alcohol consumption were progressively weaker in CBT + CE and CBT + ECE than in CBT alone. Changes in alcohol dependence and depression did not differ across conditions. CONCLUSIONS: These data do not indicate that addition of clinic-based CE to standard CBT improves outcomes. A different approach to the management of craving may be required.
RCT Entities:
AIM: To test whether addition of moderation-orientated cue exposure (CE) or CE after dysphoric mood induction (emotional CE, ECE) improved outcomes above those from cognitive-behaviour therapy alone (CBT) in people who drank when dysphoric. DESIGN: Multi-site randomized controlled trial comparing CBT with CBT + CE and CBT + ECE. SETTING: Out-patient rooms in academic treatment units in Brisbane and Sydney, Australia. PARTICIPANTS: People with alcohol misuse and problems controlling consumption when dysphoric (n = 163). Those with current major depressive episode were excluded. INTERVENTION: Eight weekly 75-minute sessions of individual treatment for alcohol problems were given to all participants, with CBT elements held constant across conditions. From session 2, CBT + CE participants resisted drinking while exposed to alcohol cues, with two priming doses of their preferred beverage being given in some sessions. After an initial CE session, CBT + ECEparticipants recalled negative experiences before undertaking CE, to provide exposure to emotional cues of personal relevance. MEASUREMENTS: Alcohol consumption, related problems, alcohol expectancies, self-efficacy and depression. RESULTS: Average improvements were highly significant across conditions, with acceptable maintenance of effects over 12 months. Both treatment retention and effects on alcohol consumption were progressively weaker in CBT + CE and CBT + ECE than in CBT alone. Changes in alcohol dependence and depression did not differ across conditions. CONCLUSIONS: These data do not indicate that addition of clinic-based CE to standard CBT improves outcomes. A different approach to the management of craving may be required.
Authors: Sarah W Feldstein Ewing; Francesca M Filbey; Lindsay D Chandler; Kent E Hutchison Journal: Alcohol Clin Exp Res Date: 2009-12-17 Impact factor: 3.455
Authors: Michael E Saladin; Kevin M Gray; Matthew J Carpenter; Steven D LaRowe; Stacia M DeSantis; Himanshu P Upadhyaya Journal: Am J Addict Date: 2012 May-Jun