Department of Psychology, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany.
Salus Clinic Lindow, Lindow, Germany.
Eur Addict Res. 2024;30(2):94-102. doi: 10.1159/000537811. Epub 2024 Mar 19.
Abstinence rates after inpatient treatment for alcohol use disorder (AUD) are modest (1-year rate around 50%). One promising approach is to re-train the automatically activated action tendency to approach alcohol-related stimuli (alcohol-approach bias) in AUD patients, as add-on to regular treatment. As efficacy has been demonstrated in well-controlled randomized controlled trials, the important next step is to add alcohol-approach-bias modification (alcohol-ApBM) to varieties of existing treatments for AUD. Therefore, this prospective, multicenter implementation-RCT examined whether adding alcohol-ApBM to regular treatments (various abstinence-oriented treatments including both individual and group-based interventions) would significantly increase abstinence rates compared to receiving regular treatment only, in a variety of naturalistic settings with different therapeutic approaches.
A total of 1,586 AUD inpatients from 9 German rehabilitation clinics were randomly assigned to receive either ApBM in addition to regular treatment or not. Training satisfaction of patients and therapists was measured after training. Success rates were determined at 3, 6, and 12 months post-treatment.
Return rates of the post-treatment assessments varied greatly between clinics, often being low (18-76%). Nevertheless, ApBM significantly increased success rates after 3 months. After 6 and 12 months, the differences were not significant. ApBM was evaluated mostly positively by patients and therapists.
DISCUSSION/CONCLUSION: ApBM was an effective add-on to regular treatment of AUD at 3 months follow-up, across a variety of AUD treatment settings. However, low return rates for the clinical outcomes reduced the effect size of ApBM considerably. The application of ApBM proved feasible in varying clinical settings, offering the opportunity to modify automatic processes and to promote abstinence.
住院治疗酒精使用障碍（AUD）后的禁欲率适中（1 年率约为 50%）。一种有前途的方法是重新训练 AUD 患者对酒精相关刺激的自动激活行为倾向（酒精趋近偏差），作为常规治疗的附加手段。由于在严格控制的随机对照试验中已证明其疗效，因此重要的下一步是将酒精趋近偏差修正（酒精-ApBM）添加到各种现有的 AUD 治疗中。因此，这项前瞻性、多中心实施的 RCT 研究了在各种自然环境中，与各种不同的治疗方法相结合，将酒精-ApBM 添加到常规治疗（包括个体和基于群体的干预在内的各种禁欲为导向的治疗）中，是否会比仅接受常规治疗显著提高禁欲率。
共有 1586 名来自德国 9 家康复诊所的 AUD 住院患者被随机分配接受 ApBM 加常规治疗或不接受 ApBM。训练后测量患者和治疗师的训练满意度。在治疗后 3、6 和 12 个月时确定成功率。
治疗后评估的回复率在诊所之间差异很大，通常很低（18-76%）。尽管如此，ApBM 在 3 个月后显著提高了成功率。在 6 个月和 12 个月后，差异不显著。患者和治疗师对 ApBM 的评价大多是积极的。
讨论/结论：在各种 AUD 治疗环境中，ApBM 在 3 个月的随访中是常规治疗 AUD 的有效附加手段。然而，临床结果的低回复率大大降低了 ApBM 的效果大小。ApBM 的应用在不同的临床环境中被证明是可行的，为修改自动过程和促进禁欲提供了机会。
