Amy Peacock1, Brian Eastwood2, Andrew Jones3, Tim Millar4, Patrick Horgan5, Jonathan Knight5, Kulvir Randhawa5, Martin White5, John Marsden6. 1. National Drug and Alcohol Research Centre, University of New South Wales, Randwick, Sydney, 2052, New South Wales, Australia; Department of Psychology, School of Medicine, University of Tasmania, Private Bag 30, Hobart, 7001, Tasmania, Australia. 2. Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, 80 London Road, London, SE1 6LH, United Kingdom. 3. Centre for Epidemiology, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom. 4. Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, England, United Kingdom. 5. Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom. 6. Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, 80 London Road, London, SE1 6LH, United Kingdom. Electronic address: john.marsden@kcl.ac.uk.
Abstract
BACKGROUND: This was a national English observational cohort study using administrative data to estimate the effectiveness of community pharmacological and psychosocial treatment for alcohol use disorder (AUD). METHODS: All adults commencing AUD treatment in the community reported to the National Drug Treatment Monitoring System (April 1 2014-March 31 2015; N = 52,499). Past 28-day admission drinking pattern included drinks per drinking day (DDD): 0 ('Abstinent'), 1-15 ('Low-High'), 16-30 ('High-Extreme') and over 30 DDD ('Extreme'). The primary outcome was successful completion of treatment within 12 months of commencement with no re-presentation (SCNR) in the subsequent six months, analysed by multi-level, mixed effects, multivariable logistic regression. RESULTS: The majority reported DDD in the 'Low-High' (n = 17,698, 34%) and 'High-Extreme' (n = 21,383, 41%) range. Smaller proportions were categorised 'Extreme' (n = 7759, 15%) and 'Abstinent' (n = 5661, 11%). Three-fifths (58%) achieved SCNR. Predictors of SCNR were older age, black/minority ethnic group, employment, criminal justice system referral, and longer treatment exposure. Predictors of negative outcome were AUD treatment history, lower socio-economic status, housing problems, and 'Extreme' drinking at admission. In addition to psychosocial interventions, pharmacological interventions and recovery support increased the likelihood of SCNR. Pharmacological treatment was only beneficial for the 'Low-High' groups with recovery support. CONCLUSIONS: Over half of all patients admitted for community AUD treatment in England are reported to successfully complete treatment within 12 months and are not re-admitted for further treatment in the following 6 months. Study findings underscore efforts to tailor AUD treatment to the severity of alcohol consumption and using recovery support.
BACKGROUND: This was a national English observational cohort study using administrative data to estimate the effectiveness of community pharmacological and psychosocial treatment for alcohol use disorder (AUD). METHODS: All adults commencing AUD treatment in the community reported to the National Drug Treatment Monitoring System (April 1 2014-March 31 2015; N = 52,499). Past 28-day admission drinking pattern included drinks per drinking day (DDD): 0 ('Abstinent'), 1-15 ('Low-High'), 16-30 ('High-Extreme') and over 30 DDD ('Extreme'). The primary outcome was successful completion of treatment within 12 months of commencement with no re-presentation (SCNR) in the subsequent six months, analysed by multi-level, mixed effects, multivariable logistic regression. RESULTS: The majority reported DDD in the 'Low-High' (n = 17,698, 34%) and 'High-Extreme' (n = 21,383, 41%) range. Smaller proportions were categorised 'Extreme' (n = 7759, 15%) and 'Abstinent' (n = 5661, 11%). Three-fifths (58%) achieved SCNR. Predictors of SCNR were older age, black/minority ethnic group, employment, criminal justice system referral, and longer treatment exposure. Predictors of negative outcome were AUD treatment history, lower socio-economic status, housing problems, and 'Extreme' drinking at admission. In addition to psychosocial interventions, pharmacological interventions and recovery support increased the likelihood of SCNR. Pharmacological treatment was only beneficial for the 'Low-High' groups with recovery support. CONCLUSIONS: Over half of all patients admitted for community AUD treatment in England are reported to successfully complete treatment within 12 months and are not re-admitted for further treatment in the following 6 months. Study findings underscore efforts to tailor AUD treatment to the severity of alcohol consumption and using recovery support.
Authors: Emmert Roberts; Matthew Hotopf; John Strang; John Marsden; Martin White; Brian Eastwood; Colin Drummond Journal: Lancet Reg Health Eur Date: 2021-04