Stasiewicz Paul R, Bradizza Clara M, Lucke Joseph F, Zhao Junru, Dermen Kurt H, Linn Braden K, Slosman Kim S, LaBarre Charles
School of Social Work, University at Buffalo, Buffalo, New York, USA.
Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Alcohol Clin Exp Res (Hoboken). 2023 Mar;47(3):549-565. doi: 10.1111/acer.15022. Epub 2023 Feb 17.
Pretreatment reductions in drinking are well documented and have been demonstrated to predict posttreatment drinking outcomes. Making use of the predictive value of pretreatment change has great appeal in settings that place a premium on efficient clinical decisions regarding appropriate type and intensity of treatment.
This study investigates whether different types and intensities of treatment are appropriate and beneficial for individuals entering treatment for an alcohol use disorder (AUD; N = 201) who make more vs. less pretreatment change in their drinking during a 2-month pretreatment period. Based on an algorithm derived from pilot research, we derived two independent pretreatment change arms that we called Substantial Change and Minimal Change. Each arm was a parallel, sequentially randomized design consisting of a treatment group and an active control. The Substantial Change arm compared six sessions of relapse prevention treatment (RPT) with 12 sessions of cognitive behavioral therapy for AUD (CBT) as an active control. Both CBT and RPT occurred over a 12-week period. The Minimal Change arm compared 12 sessions of an integrated motivational intervention combined with CBT (MI/CBT) with 12 sessions of CBT as an active control. The outcome variables were changes in number of days abstinent (NDA) and number of days heavy drinking (NDH) per week.
For the Substantial Change arm, a noninferiority analysis revealed that six sessions of RPT were noninferior to 12 sessions of CBT at each posttreatment assessment for both NDA and NDH. For the Minimal Change arm, a superiority analysis failed to detect that MI/CBT was superior to CBT at any posttreatment assessment for both NDA and NDH.
In the substantial change arm, results suggest that offering a less intensive initial treatment, like RPT, may lower costs and conserve clinical resources. In the Minimal Change arm, results indicate the need to continue searching for a treatment or treatment enhancements to improve alcohol outcomes.
治疗前饮酒量的减少已有充分记录，并且已证明可预测治疗后的饮酒结果。在重视关于适当治疗类型和强度的高效临床决策的环境中，利用治疗前变化的预测价值具有很大吸引力。
本研究调查了对于因酒精使用障碍（AUD；N = 201）而接受治疗的个体，不同类型和强度的治疗是否合适且有益，这些个体在为期2个月的治疗前期饮酒量变化较大或较小。基于先导研究得出的算法，我们得出了两个独立的治疗前期变化组，我们称之为显著变化组和微小变化组。每组均为平行、序贯随机设计，包括一个治疗组和一个积极对照组。显著变化组将六次复发预防治疗（RPT）与十二次酒精使用障碍认知行为疗法（CBT）作为积极对照进行比较。CBT和RPT均在12周内进行。微小变化组将十二次综合动机干预联合CBT（MI/CBT）与十二次CBT作为积极对照进行比较。结果变量为每周戒酒天数（NDA）和重度饮酒天数（NDH）的变化。
对于显著变化组，非劣效性分析显示，在每次治疗后评估中，六次RPT在NDA和NDH方面均不劣于十二次CBT。对于微小变化组，优效性分析未能发现MI/CBT在任何治疗后评估中在NDA和NDH方面优于CBT。
在显著变化组中，结果表明提供强度较低的初始治疗，如RPT，可能会降低成本并节省临床资源。在微小变化组中，结果表明需要继续寻找一种治疗方法或治疗改进措施以改善酒精相关结果。
