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.
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.
Drug Alcohol Depend. 2018 May 1;186:60-67. doi: 10.1016/j.drugalcdep.2018.01.019. Epub 2018 Mar 13.
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).
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.
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.
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.
本研究采用全国性的英文观察队列研究，利用行政数据评估社区药物和心理社会治疗对酒精使用障碍（AUD）的疗效。
所有在社区开始 AUD 治疗的成年人都向国家药物治疗监测系统报告（2014 年 4 月 1 日至 2015 年 3 月 31 日；N=52499）。过去 28 天的入院饮酒模式包括饮酒日的饮酒量（DDD）：0（“戒酒”）、1-15（“低-高”）、16-30（“高-极高”）和超过 30 DDD（“极高”）。主要结局是在开始治疗后的 12 个月内成功完成治疗，并且在接下来的 6 个月内没有再次出现（SCNR），采用多水平、混合效应、多变量逻辑回归进行分析。
大多数人报告的 DDD 范围在“低-高”（n=17698，34%）和“高-极高”（n=21383，41%）。较小的比例被归类为“极高”（n=7759，15%）和“戒酒”（n=5661，11%）。五分之三（58%）达到 SCNR。SCNR 的预测因素为年龄较大、黑人/少数族裔、就业、刑事司法系统转介和更长的治疗暴露。SCNR 不良结局的预测因素为 AUD 治疗史、较低的社会经济地位、住房问题和入院时的“极高”饮酒量。除了心理社会干预外，药物干预和康复支持增加了 SCNR 的可能性。药物治疗仅对接受康复支持的“低-高”组有益。
在英格兰，接受社区 AUD 治疗的所有患者中，超过一半的患者报告在 12 个月内成功完成治疗，并且在接下来的 6 个月内没有因进一步治疗而再次入院。研究结果强调了根据酒精摄入量的严重程度调整 AUD 治疗方法和使用康复支持的重要性。
