Center for Studies of Addiction, Perelman School of Medicine. University of Pennsylvania, Philadelphia, PA, USA.
Crescenz VAMC, Philadelphia, PA, USA.
Addiction. 2022 May;117(5):1326-1337. doi: 10.1111/add.15771. Epub 2021 Dec 23.
Management of alcohol use disorder (AUD) could be enhanced by effective remote treatments. This study tested whether supplementing intensive outpatient programs (IOPs) with continuing care delivered via (1) telephone, (2) smartphone or (3) their combination improves outcomes relative to (4) IOP only. Continuing care conditions were also compared.
Randomized controlled trial of four groups with 3-, 6-, 9-, 12- and 18-month follow-ups.
University research center in Philadelphia, PA, USA.
Participants (n = 262) met DSM-V criteria for AUD, were largely male (71%) and African American (82%).
Telephone monitoring and counseling (TMC; n = 59), addiction comprehensive health enhancement support system (ACHESS; n = 68) and TMC + ACHESS (n = 70) provided for 12 months. The control condition received IOP only (TAU; n = 65).
The primary outcome was percentage of days heavy drinking (PDHD) in months 1-12. Secondary outcomes were any drinking, any drug use, drinking consequences and quality of life.
Mean PDHD in months 1-12 was 10.29 in TAU, 5.41 in TMC, 6.80 in ACHESS and 5.99 in TMC + ACHESS. PDHD was lower in TMC [Cohen's d = 0.35, P = 0.018, 95% confidence interval (CI) = (-1.42, -0.20)], ACHESS [d = 0.31, P = 0.031, 95% CI = (-1.27, -0.06)] and TMC + ACHESS [d = 0.36, P = 0.009, 95% CI = (-1.40, -0.20)] than in TAU. Differences between TMC + ACHESS, TMC and ACHESS were small (d ≤ 0.06) and non-significant. Findings were inconclusive as to whether or not the treatment conditions differed on PDHD at 18 months. A significant effect was obtained on any drinking, which was higher in months 1-12 in TAU than in TMC [odds ratio (OR) = 3.02, standard error (SE) = 0.43, 95% CI = (1.30, 6.99), P = 0.01] and TMC + ACHESS [OR = 2.43, SE = 0.39, 95% CI = (1.12, 5.27), P = 0.025). No other significant effects were obtained on other secondary outcomes during or after treatment.
A telephone-delivered intervention and a smartphone-delivered intervention, alone and in combination, provided effective remote continuing care for alcohol use disorder. The combination of both interventions was not superior to either alone and effects did not persist post-treatment.
有效的远程治疗可以改善酒精使用障碍（AUD）的管理。本研究测试了通过（1）电话、（2）智能手机或（3）两者的组合来补充强化门诊治疗（IOP），是否能改善治疗效果，与（4）仅IOP 治疗相比。还比较了继续护理条件。
为期 3、6、9、12 和 18 个月随访的四组随机对照试验。
美国宾夕法尼亚州费城的大学研究中心。
参与者（n=262）符合 DSM-V 酒精使用障碍标准，主要为男性（71%）和非裔美国人（82%）。
电话监测和咨询（TMC；n=59）、综合成瘾健康增强支持系统（ACHESS；n=68）和 TMC+ACHESS（n=70）提供 12 个月的治疗。对照组仅接受 IOP 治疗（TAU；n=65）。
主要结果是 1-12 个月内的大量饮酒天数百分比（PDHD）。次要结果是任何饮酒、任何药物使用、饮酒后果和生活质量。
1-12 个月内 TAU、TMC、ACHESS 和 TMC+ACHESS 的平均 PDHD 分别为 10.29、5.41、6.80 和 5.99。TMC [Cohen's d=0.35，P=0.018，95%置信区间（CI）=（-1.42，-0.20）]、ACHESS [d=0.31，P=0.031，95% CI=（-1.27，-0.06）]和 TMC+ACHESS [d=0.36，P=0.009，95% CI=（-1.40，-0.20）]的 PDHD 均低于 TAU。TMC+ACHESS、TMC 和 ACHESS 之间的差异较小（d≤0.06）且无统计学意义。在 18 个月时，治疗条件在 PDHD 上是否存在差异的结果并不确定。在任何饮酒方面均获得了显著效果，1-12 个月内 TAU 的任何饮酒均高于 TMC [比值比（OR）=3.02，标准误差（SE）=0.43，95% CI=（1.30，6.99），P=0.01]和 TMC+ACHESS [OR=2.43，SE=0.39，95% CI=（1.12，5.27），P=0.025）]。在治疗期间或治疗后，其他次要结果均未获得其他显著效果。
通过电话和智能手机提供的干预措施，单独或联合使用，为酒精使用障碍提供了有效的远程持续护理。两种干预措施的联合使用并不优于单独使用，并且治疗后效果也不会持续。
