Buckman J E J, Naismith I, Saunders R, Morrison T, Linke S, Leibowitz J, Pilling S
Research Department of Clinical,Educational and Health Psychology,University College London,Gower Street,LondonWC1E 6BT.
Universidad de los Andes,Cra. 1 #18a-12,Bogotá,Colombia.
Behav Cogn Psychother. 2018 Sep;46(5):513-527. doi: 10.1017/S1352465817000819. Epub 2018 Feb 26.
The impact of alcohol use disorders (AUD) on psychological treatments for depression or anxiety in primary care psychological treatment services is unknown.
To establish levels of alcohol misuse in an Improving Access to Psychological Therapies (IAPT) service, examine the impact of higher risk drinking on IAPT treatment outcomes and drop-out, and to inform good practice in working with alcohol misuse in IAPT services.
3643 patients completed a brief questionnaire on alcohol use pre-treatment in addition to measures of depression, anxiety and functioning. Symptom and functioning measures were re-administered at all treatment sessions.
Severity of alcohol misuse was not associated with treatment outcomes, although those scoring eight or more on the AUDIT-C were more likely to drop out from treatment.
IAPT services may be well placed to offer psychological therapies to patients with common mental disorders and comorbid AUD. Patients with AUD can have equivalent treatment outcomes to those without AUD, but some higher risk drinkers may find accessing IAPT treatment more difficult as they are more likely to drop out. Alcohol misuse on its own should not be used as an exclusion criterion from IAPT services. Recommendations are given as to how clinicians can: adjust their assessments to consider the appropriateness of IAPT treatment for patients that misuse alcohol, consider the potential impact of alcohol misuse on treatment, and improve engagement in treatment for higher risk drinkers.
在初级保健心理治疗服务中，酒精使用障碍（AUD）对抑郁症或焦虑症心理治疗的影响尚不清楚。
确定改善心理治疗可及性（IAPT）服务中酒精滥用的程度，研究高风险饮酒对IAPT治疗结果和退出治疗的影响，并为IAPT服务中处理酒精滥用问题提供良好实践指导。
3643名患者在治疗前除完成一份关于酒精使用的简短问卷外，还接受了抑郁、焦虑和功能方面的测量。在所有治疗阶段均重新进行症状和功能测量。
酒精滥用的严重程度与治疗结果无关，尽管酒精使用障碍识别测试-消费版（AUDIT-C）得分在8分及以上的患者更有可能退出治疗。
IAPT服务可能适合为患有常见精神障碍和合并AUD的患者提供心理治疗。患有AUD的患者与未患AUD的患者可能有相同的治疗结果，但一些高风险饮酒者可能会发现接受IAPT治疗更困难，因为他们更有可能退出。不应仅将酒精滥用作为IAPT服务的排除标准。针对临床医生如何：调整评估以考虑IAPT治疗对酒精滥用患者的适用性、考虑酒精滥用对治疗的潜在影响以及提高高风险饮酒者的治疗参与度给出了建议。
