Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Addiction. 2023 Jul;118(7):1232-1243. doi: 10.1111/add.16157. Epub 2023 Feb 23.
Most alcohol-dependent people have a moderate level of dependence. General practitioners (GPs) hesitate to engage in this area, and need to have access to treatment they find applicable and feasible to use. The aim of this present study was to test if an open-ended internet-based cognitive-behavioral therapy (iCBT) program added to treatment-as-usual (TAU) is more effective than TAU-only for alcohol-dependent patients in primary care.
DESIGN, SETTING AND PARTICIPANTS: The present study was a two-group, parallel, randomized controlled superiority trial comparing iCBT+TAU versus TAU-only at 3- and 12-month follow-ups. TAU was delivered at 14 primary care centers in Stockholm, Sweden. A total of 264 patients (mean age 51 years, of whom 148 were female and 116 were male) with alcohol dependence and hazardous alcohol consumption were enrolled between September 2017 and November 2019.
Participants were randomized at a ratio of 1:1 to iCBT, as a self-help intervention added to TAU (n = 132) or to TAU-only (n = 132). The GPs gave participants in both treatment arms feedback on the assessments and biomarkers and offered TAU at the primary care center. Primary outcome was weekly alcohol consumption in g/week at 12-month follow-up, analyzed according to intention-to-treat (n = 132 + 132). The per-protocol analysis included participants who completed at least one module of iCBT (n = 102 + 132).
There was no significant difference in weekly alcohol consumption between iCBT+TAU and TAU in the intention-to-treat (ITT) analysis at 12-month follow-up [iCBT+TAU = 133.56 (95% confidence interval, CI = 100.94-166.19) and TAU = 176.20 (95% CI = 144.04-208.35), P = 0.068, d = 0.23]. In the per-protocol analysis, including only those who initiated iCBT, the iCBT+TAU group showed lower mean weekly alcohol consumption compared with TAU [iCBT+TAU = 107.46 (95% CI = 71.17-143.74), TAU = 176.00 (95% CI = 144.21-207.80), P = 0.010, d = 0.42].
In Sweden, an internet-based cognitive-behavioral program added to treatment-as-usual to reduce alcohol consumption showed weak evidence of a benefit at 12 months in the intention-to-treat analysis and good evidence of a benefit in the per-protocol analysis.
大多数酒精依赖者都有中度依赖。全科医生（GP）在这方面犹豫不决，他们需要获得他们认为适用且可行的治疗方法。本研究的目的是测试在初级保健中，为酒精依赖患者提供开放式基于互联网的认知行为疗法（iCBT）是否比仅接受常规治疗（TAU）更有效。
设计、地点和参与者：本研究是一项两臂、平行、随机对照优势试验，比较了 iCBT+TAU 与 TAU 仅在 3 个月和 12 个月随访时的效果。TAU 在瑞典斯德哥尔摩的 14 个初级保健中心进行。共有 264 名（平均年龄 51 岁，其中 148 名女性，116 名男性）有酒精依赖和危险饮酒的患者于 2017 年 9 月至 2019 年 11 月期间入组。
参与者按照 1:1 的比例随机分配到 iCBT 组（作为添加到 TAU 的自我帮助干预）或 TAU 组（n=132）。GP 对两组治疗组的评估和生物标志物进行反馈，并在初级保健中心提供 TAU。主要结局是 12 个月随访时每周的酒精摄入量（g/周），采用意向治疗（ITT）（n=132+132）进行分析。方案分析包括至少完成一个 iCBT 模块的参与者（n=102+132）。
在 12 个月的随访中，iCBT+TAU 组与 TAU 组在 ITT 分析中每周的酒精摄入量没有显著差异[iCBT+TAU=133.56（95%置信区间，CI=100.94-166.19）和 TAU=176.20（95%CI=144.04-208.35），P=0.068，d=0.23]。在方案分析中，仅包括那些开始接受 iCBT 的参与者，iCBT+TAU 组的平均每周酒精摄入量低于 TAU 组[iCBT+TAU=107.46（95%CI=71.17-143.74），TAU=176.00（95%CI=144.21-207.80），P=0.010，d=0.42]。
在瑞典，将基于互联网的认知行为疗法添加到常规治疗中以减少饮酒量的方案显示，在 ITT 分析中，在 12 个月时具有微弱的获益证据，在方案分析中具有良好的获益证据。
