Alcohol Dependence
Conditions
Keywords
alcoholism, primary care, treatment
Brief summary
A randomized study of Alcohol Care Management for the treatment of alcohol dependence in primary care settings.
Detailed description
Background: Alcohol dependence is one of the leading causes of disability worldwide. Despite the availability of efficacious treatments less than 20% of individuals with alcohol dependence are actively engaged in treatment. Within the VA system systematic screening was implemented to increase the identification of patients with both abuse and dependence. However, there continues to be a marked discrepancy in the care offered or accessed among those identified with alcohol dependence. Existing treatment guidelines suggest that all persons with dependence receive care in specialty addiction treatment. Data from our center indicate that among those individuals screened in primary care who have AUDIT - C scores of \>7, only 30% are formally evaluated with 50% receiving only brief advice and 20% having no evidence of assessment or referral. Of those assessed and referred to specialty care only 60% attend an initial visit and only 33% meet the EPRP performance measure of 2 visits per month for 90 days. This disparity in treatment access exists even though Veterans self report a desire to cut down and readiness to change drinking behaviors. (VA ACQUIP) and a willingness to consider pharmacotherapy. Aims: Available evidence suggests that primary care may be a key component in the identification of alcohol dependent patients, delivery of initial interventions, and to the success of addiction treatment. Indeed, the vast majority of screening and new case identification occurs within primary care. The primary aims of this proposal are to test the effectiveness of a primary care based Alcohol Care Management (ACM) program and to evaluate the barriers and facilitators to accessing and engaging individuals into treatment. The ACM program uses a Behavioral Health Specialist to deliver care focused on the use of pharmacotherapy in combination with psychosocial support (Medication Management). This model may overcome barriers to care such as frequent intensive visit schedules often required in specialty settings, stigma associated with specialty care or group therapy approaches, access to specialty care in remote areas, and the current focus on a 12 step model of treatment. Secondary aims are to establish the acceptability of primary care based treatments and defining treatment modifiers such as age, barriers, co-occurring depression, and pharmacogenetic response.
Interventions
BEHAVIORALAlcohol Care Management
Care management for alcohol dependence with a focus on pharmacotherapy
BEHAVIORALUsual Care
Usual care included a referral to a specialty addiction treatment program.
Sponsors
US Department of Veterans Affairs
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* be men and women = 18 years of age; * meet criteria for alcohol dependence; * drink more than an average of 2 drinks per day prior to study entry (over the last 60 days); * have adequate hearing to participate in assessment
Exclusion criteria
* show no evidence of current abuse or dependence of illicit substances other than marijuana; * no current hallucinations; * no current symptoms of mania; * be relatively cognitively intact * not actively participate in specialized addition or behavioral health treatment within the prior 12 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Treatment Engagement | 6 months | This measured the percentage of subjects who attended at least 2 clinical addiction sessions in a given month. The outcome presented is the percentage during the 6th month of the trial. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent Days of Heavy Alcohol Use | 6 months | This is a measure during the 6 month of the percentage of 30 days in which a subject had at least 1 day of heavy drinking as defined by drinking more than 4 standard drinks in a day (3 or more for women). |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Arm 1 Care management for alcohol dependence
Alcohol Care Management: Care management for alcohol dependence with a focus on pharmacotherapy | 85 |
| Arm 2 Usual care
Alcohol Care Management: Care management for alcohol dependence with a focus on pharmacotherapy | 78 |
| Total | 163 |
Baseline characteristics
| Characteristic | Arm 1 | Arm 2 | Total |
|---|---|---|---|
| Age, Continuous | 54.9 years STANDARD_DEVIATION 11.4 | 57.1 years STANDARD_DEVIATION 10.1 | 56 years STANDARD_DEVIATION 10.8 |
| % Days of Heavy Drinking | 54.5 % days of heavy drinking STANDARD_DEVIATION 53.8 | 54.7 % days of heavy drinking STANDARD_DEVIATION 33.6 | 54.6 % days of heavy drinking STANDARD_DEVIATION 44.1 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 50 Participants | 44 Participants | 94 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 35 Participants | 34 Participants | 69 Participants |
| Region of Enrollment United States | 85 participants | 78 participants | 163 participants |
| Sex: Female, Male Female | 0 Participants | 5 Participants | 5 Participants |
| Sex: Female, Male Male | 85 Participants | 73 Participants | 158 Participants |
| The number of Subjects Engaged in Treatment at Baseline | 0 Participants engaged in treatment | 0 Participants engaged in treatment | 0 Participants engaged in treatment |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 85 | 0 / 78 |
| serious Total, serious adverse events | 0 / 85 | 0 / 78 |
Outcome results
Primary
Treatment Engagement
This measured the percentage of subjects who attended at least 2 clinical addiction sessions in a given month. The outcome presented is the percentage during the 6th month of the trial.
Time frame: 6 months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 1 | Treatment Engagement | 36 percentage of participants engaged |
| Arm 2 | Treatment Engagement | 9 percentage of participants engaged |
Secondary
Percent Days of Heavy Alcohol Use
This is a measure during the 6 month of the percentage of 30 days in which a subject had at least 1 day of heavy drinking as defined by drinking more than 4 standard drinks in a day (3 or more for women).
Time frame: 6 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm 1 | Percent Days of Heavy Alcohol Use | 18.0 percentage of heavy drinking days | Standard Deviation 30.7 |
| Arm 2 | Percent Days of Heavy Alcohol Use | 25.6 percentage of heavy drinking days | Standard Deviation 33 |