Let’s not turn back the clock: Comments on Kelly et al., “Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers”

2020 ◽  
Author(s):  
Nick Heather
Keyword(s):  
Alcohol Use ◽  
Alcoholics Anonymous ◽  
Alcohol Use Disorder ◽  
Cochrane Review ◽  
Policy Makers

scholarly journals Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers

2020 ◽  
Vol 55 (6) ◽  
pp. 641-651 ◽  
Author(s):  
John F Kelly ◽  
Alexandra Abry ◽  
Marica Ferri ◽  
Keith Humphreys
Keyword(s):  
Alcohol Use ◽  
Alcoholics Anonymous ◽  
Alcohol Use Disorder ◽  
English Language ◽  
Health Care Cost ◽  
Theoretical Orientation ◽  
Cochrane Review ◽  
Economic Benefits ◽  
Motivational Enhancement Therapy ◽  
Cost Offset

ABSTRACT Aims A recently completed Cochrane review assessed the effectiveness and cost-benefits of Alcoholics Anonymous (AA) and clinically delivered 12-Step Facilitation (TSF) interventions for alcohol use disorder (AUD). This paper summarizes key findings and discusses implications for practice and policy. Methods Cochrane review methods were followed. Searches were conducted across all major databases (e.g. Cochrane Drugs and Alcohol Group Specialized Register, PubMed, Embase, PsycINFO and ClinicalTrials.gov) from inception to 2 August 2019 and included non-English language studies. Randomized controlled trials (RCTs) and quasi-experiments that compared AA/TSF with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants or no treatment, were included. Healthcare cost offset studies were also included. Studies were categorized by design (RCT/quasi-experimental; nonrandomized; economic), degree of manualization (all interventions manualized versus some/none) and comparison intervention type (i.e. whether AA/TSF was compared to an intervention with a different theoretical orientation or an AA/TSF intervention that varied in style or intensity). Random-effects meta-analyses were used to pool effects where possible using standard mean differences (SMD) for continuous outcomes (e.g. percent days abstinent (PDA)) and the relative risk ratios (RRs) for dichotomous. Results A total of 27 studies (21 RCTs/quasi-experiments, 5 nonrandomized and 1 purely economic study) containing 10,565 participants were included. AA/TSF interventions performed at least as well as established active comparison treatments (e.g. CBT) on all outcomes except for abstinence where it often outperformed other treatments. AA/TSF also demonstrated higher health care cost savings than other AUD treatments. Conclusions AA/TSF interventions produce similar benefits to other treatments on all drinking-related outcomes except for continuous abstinence and remission, where AA/TSF is superior. AA/TSF also reduces healthcare costs. Clinically implementing one of these proven manualized AA/TSF interventions is likely to enhance outcomes for individuals with AUD while producing health economic benefits.

scholarly journals Medication-enhanced behavior therapy for alcohol use disorder: Naltrexone, Alcoholics Anonymous Facilitation, and OPRM1 genetic variation

2019 ◽  
Vol 104 ◽  
pp. 7-14
Author(s):  
Scott H. Stewart ◽  
Kimberly S. Walitzer ◽  
Javier Blanco ◽  
Denise Swiatek ◽  
Linda Paine Hughes ◽  
...  
Keyword(s):  
Genetic Variation ◽  
Alcohol Use ◽  
Behavior Therapy ◽  
Alcoholics Anonymous ◽  
Alcohol Use Disorder

Alcohol Use Disorders and Clinical Management

2017 ◽  
Author(s):  
Alexander Thompson ◽  
Daniel Rohlf ◽  
Joseph Cocozzella
Keyword(s):  
Alcohol Use ◽  
Support Groups ◽  
Alcoholics Anonymous ◽  
Alcohol Use Disorder ◽  
The United States ◽  
Mutual Support ◽  
First Line ◽  
High Prevalence ◽  
Mutual Support Groups ◽  
The Individual

Alcohol use disorder (AUD) is the current DSM-5 designation for problematic and pathologic alcohol use. AUDs have a high prevalence in the United States and are commonly treated in psychiatric practice. They are associated with a wide variety of medical and psychiatric comorbidities. Effective treatment depends on tailoring treatment setting, behavioral psychotherapies, and psychotropic interventions to the individual patients. Three medications are Food and Drug Administration approved for the treatment of AUDs: naltrexone, acamprosate, and disulfiram. Several other medications (anticonvulsants and baclofen) have been studied, but their role in treating AUDs is uncertain. Naltrexone and/or acamprosate should be considered first-line medications for patients without contraindications. Disulfiram can be considered a second-line or first-line treatment in patients with appropriate support or those who prefer it. All patients who are diagnosed with AUDs should be referred to mutual support groups (i.e., Alcoholics Anonymous). This review contains 3 figures, 5 tables, and 35 references. Key words: acamprosate, Alcoholics Anonymous, AUDIT, brief interventions, disulfiram, gabapentin, naltrexone, topiramate, 12 step 

DSM-5 alcohol use disorder features among treatment-seeking older adults

2018 ◽  
Vol 64 (4) ◽  
pp. 185-196 ◽  
Author(s):  
Silke Behrendt ◽  
Barbara Braun ◽  
Randi Bilberg ◽  
Gerhard Bühringer ◽  
Michael Bogenschutz ◽  
...  
Keyword(s):  
Older Adults ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
The Elderly ◽  
Treatment Seeking ◽  
Controlled Clinical Trial ◽  
Dsm 5 ◽  
Wide Range ◽  
And Gender ◽  
International Multicenter

Abstract. Background: The number of older adults with alcohol use disorder (AUD) is expected to rise. Adapted treatments for this group are lacking and information on AUD features in treatment seeking older adults is scarce. The international multicenter randomized-controlled clinical trial “ELDERLY-Study” with few exclusion criteria was conducted to investigate two outpatient AUD-treatments for adults aged 60+ with DSM-5 AUD. Aims: To add to 1) basic methodological information on the ELDERLY-Study by providing information on AUD features in ELDERLY-participants taking into account country and gender, and 2) knowledge on AUD features in older adults seeking outpatient treatment. Methods: baseline data from the German and Danish ELDERLY-sites (n=544) were used. AUD diagnoses were obtained with the Mini International Neuropsychiatric Interview, alcohol use information with Form 90. Results: Lost control, desired control, mental/physical problem, and craving were the most prevalent (> 70 %) AUD-symptoms. 54.9 % reported severe DSM-5 AUD (moderate: 28.2 %, mild: 16.9 %). Mean daily alcohol use was 6.3 drinks at 12 grams ethanol each. 93.9 % reported binging. More intense alcohol use was associated with greater AUD-severity and male gender. Country effects showed for alcohol use and AUD-severity. Conclusion: European ELDERLY-participants presented typical dependence symptoms, a wide range of severity, and intense alcohol use. This may underline the clinical significance of AUD in treatment-seeking seniors.

Persönliche vs. computerbasierte Alkoholintervention für Krankenhauspatienten: Studiendesign

2015 ◽  
Vol 61 (6) ◽  
pp. 347-355 ◽  
Author(s):  
Jennis Freyer-Adam ◽  
Sophie Baumann ◽  
Inga Schnuerer ◽  
Katja Haberecht ◽  
Ulrich John ◽  
...  
Keyword(s):  
Public Health ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Identification Test ◽  
Disorder Identification

Zusammenfassung. Ziel: Persönliche Beratungen können bei stationären Krankenhauspatienten Alkoholkonsum und Mortalität reduzieren. Sie sind jedoch mit hohen Kosten verbunden, wenn aus Public-Health-Erfordernis viele Menschen einer Bevölkerung erreicht werden müssen. Computerbasierte Interventionen stellen eine Alternative dar. Jedoch ist ihre Wirksamkeit im Vergleich zu persönlichen Beratungen und im Allgemeinkrankenhaus noch unklar. Eine quasi-randomisierte Kontrollgruppenstudie „Die Bedeutung der Vermittlungsform für Alkoholinterventionen bei Allgemeinkrankenhauspatienten: Persönlich vs. Computerisiert“ soll dies untersuchen. Design und Methoden werden beschrieben. Methode: Über 18 Monate sind alle 18- bis 64-jährigen Patienten auf Stationen der Universitätsmedizin Greifswald mittels Alcohol Use Disorder Identification Test (AUDIT) zu screenen. Frauen/Männer mit AUDIT-Consumption ≥ 4/5 und AUDIT < 20 werden einer von drei Gruppen zugeordnet: persönliche Intervention (Beratungen zur Konsumreduktion), computerbasierte Intervention (individualisierte Rückmeldebriefe und Broschüren) und Kontrollgruppe. Beide Interventionen erfolgen im Krankenhaus sowie telefonisch bzw. postalisch nach 1 und 3 Monaten. In computergestützten Telefoninterviews nach 6, 12, 18 und 24 Monaten wird Alkoholkonsum erfragt. Schlussfolgerung: Das Studienvorhaben, sofern erfolgreich umgesetzt, ist geeignet die längerfristige Wirksamkeit einer persönlichen und computerbasierten Intervention im Vergleich zu untersuchen.

Sign in / Sign up

Export Citation Format

Share Document