Katie Witkiewitz1, Nick Heather2, Daniel E Falk3, Raye Z Litten3, Deborah S Hasin4, Henry R Kranzler5, Karl F Mann6, Stephanie S O'Malley7, Raymond F Anton8. 1. Department of Psychology, University of New Mexico, Albuquerque, NM, USA. 2. Northumbria University, Newcastle upon Tyne, UK. 3. National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA. 4. Department of Epidemiology, Columbia University, New York, NY, USA. 5. Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA. 6. Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. 7. Yale School of Medicine, New Haven, CT, USA. 8. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
Abstract
AIMS: To examine whether World Health Organization (WHO) risk-level reductions in drinking were achievable, associated with improved functioning and maintained over time among patients at varying initial alcohol dependence severity levels. Design and setting Secondary data analysis of multi-site randomized clinical trials: the US Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study and the UK Alcohol Treatment Trial (UKATT). PARTICIPANTS: Individuals with alcohol dependence enrolled in COMBINE (n = 1383; 68.8% male) and seeking treatment for alcohol problems in UKATT (n = 742; 74.1% male). Interventions Naltrexone, acamprosate or placebo, and combined behavioral intervention or medication management in COMBINE. Social behavior network therapy or motivational enhancement therapy in UKATT. MEASUREMENTS: WHO risk-level reductions were assessed via the calendar method. Alcohol dependence was measured by the Alcohol Dependence Scale, the Leeds Dependence Questionnaire and the Diagnostic and Statistical Manual of Mental Disorders. Measures of functioning included alcohol-related consequences (Drinker Inventory of Consequences and Alcohol Problems Questionnaire), mental health (Short Form Health Survey) and liver enzyme tests. FINDINGS: One- and two-level reductions in WHO risk levels in the last month of treatment were maintained at the 1-year follow-up [adjusted odds ratio (OR), 95% confidence interval (CI) = one-level reduction in COMBINE: 3.51 (2.73, 4.29) and UKATT: 2.65 (2.32, 2.98)] and associated with fewer alcohol-related consequences [e.g. B, 95% CI = one-level reduction COMBINE: -26.22 (-30.62, -21.82)], better mental health [e.g. B, 95% CI = one-level reduction UKATT: 9.53 (7.36, 11.73)] and improvements in γ-glutamyltransferase [e.g. B, 95% CI = one-level reduction UKATT: -89.77 (-122.50, -57.04)] at the end of treatment, even among patients with severe alcohol dependence. Results were similar when abstainers were excluded. Conclusions Reductions in World Health Organization risk levels for alcohol consumption appear to be achievable, associated with better functioning and maintained over time in both the United States and the United Kingdom.
RCT Entities:
AIMS: To examine whether World Health Organization (WHO) risk-level reductions in drinking were achievable, associated with improved functioning and maintained over time among patients at varying initial alcohol dependence severity levels. Design and setting Secondary data analysis of multi-site randomized clinical trials: the US Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study and the UK Alcohol Treatment Trial (UKATT). PARTICIPANTS: Individuals with alcohol dependence enrolled in COMBINE (n = 1383; 68.8% male) and seeking treatment for alcohol problems in UKATT (n = 742; 74.1% male). Interventions Naltrexone, acamprosate or placebo, and combined behavioral intervention or medication management in COMBINE. Social behavior network therapy or motivational enhancement therapy in UKATT. MEASUREMENTS: WHO risk-level reductions were assessed via the calendar method. Alcohol dependence was measured by the Alcohol Dependence Scale, the Leeds Dependence Questionnaire and the Diagnostic and Statistical Manual of Mental Disorders. Measures of functioning included alcohol-related consequences (Drinker Inventory of Consequences and Alcohol Problems Questionnaire), mental health (Short Form Health Survey) and liver enzyme tests. FINDINGS: One- and two-level reductions in WHO risk levels in the last month of treatment were maintained at the 1-year follow-up [adjusted odds ratio (OR), 95% confidence interval (CI) = one-level reduction in COMBINE: 3.51 (2.73, 4.29) and UKATT: 2.65 (2.32, 2.98)] and associated with fewer alcohol-related consequences [e.g. B, 95% CI = one-level reduction COMBINE: -26.22 (-30.62, -21.82)], better mental health [e.g. B, 95% CI = one-level reduction UKATT: 9.53 (7.36, 11.73)] and improvements in γ-glutamyltransferase [e.g. B, 95% CI = one-level reduction UKATT: -89.77 (-122.50, -57.04)] at the end of treatment, even among patients with severe alcohol dependence. Results were similar when abstainers were excluded. Conclusions Reductions in World Health Organization risk levels for alcohol consumption appear to be achievable, associated with better functioning and maintained over time in both the United States and the United Kingdom.
Authors: Justin Knox; Jennifer Scodes; Melanie Wall; Katie Witkiewitz; Henry R Kranzler; Daniel Falk; Raye Litten; Karl Mann; Stephanie S O'Malley; Raymond Anton; Deborah S Hasin Journal: Drug Alcohol Depend Date: 2019-02-14 Impact factor: 4.492
Authors: Henri-Jean Aubin; Jens Reimer; David J Nutt; Anna Bladström; Lars Torup; Clément François; Jonathan Chick Journal: Eur Addict Res Date: 2015-03-31 Impact factor: 3.015
Authors: Katie Witkiewitz; Kevin A Hallgren; Henry R Kranzler; Karl F Mann; Deborah S Hasin; Daniel E Falk; Raye Z Litten; Stephanie S O'Malley; Raymond F Anton Journal: Alcohol Clin Exp Res Date: 2016-12-26 Impact factor: 3.455
Authors: Justin Knox; Jennifer Scodes; Katie Witkiewitz; Henry R Kranzler; Karl Mann; Stephanie S O'Malley; Melanie Wall; Raymond Anton; Deborah S Hasin Journal: Alcohol Clin Exp Res Date: 2020-07-03 Impact factor: 3.455
Authors: Deborah S Hasin; Efrat Aharonovich; Barry S Zingman; Malka Stohl; Claire Walsh; Jennifer C Elliott; David S Fink; Justin Knox; Sean Durant; Raquel Menchaca; Anjali Sharma Journal: J Subst Abuse Treat Date: 2022-01-31
Authors: Mary E McCaul; Heidi E Hutton; Karen L Cropsey; Heidi M Crane; Catherine R Lesko; Geetanjali Chander; Michael J Mugavero; Mari M Kitahata; Bryan Lau; Michael S Saag Journal: AIDS Behav Date: 2021-05-16
Authors: Vanessa A Palzes; Andrea H Kline-Simon; Derek D Satre; Stacy Sterling; Constance Weisner; Felicia W Chi Journal: Addiction Date: 2021-07-12 Impact factor: 6.526