A Randomized Clinical Trial of Alcohol Care Management Delivered in Department of Veterans Affairs Primary Care Clinics Versus Specialty Addiction Treatment
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Alcohol use disorder is one of the leading causes of disability worldwide. Despite the availability of efficacious treatments, few individuals with an alcohol use disorder are actively engaged in treatment. Available evidence suggests that primary care may play a crucial role in the identification of patients with an alcohol use disorder, delivery of interventions, and the success of treatment.
The principal aims of this study were to test the effectiveness of a primary care-based Alcohol Care Management (ACM) program for alcohol use disorder and treatment engagement in veterans.
The design of the study was a 26-week single-blind randomized clinical trial. The study was conducted in the primary care practices at three VA medical centers. Participants were randomly assigned to treatment in ACM or standard treatment in a specialty outpatient addiction treatment program.
One hundred and sixty-three alcohol-dependent veterans were randomized.
ACM focused on the use of pharmacotherapy and psychosocial support. ACM was delivered in-person or by telephone within the primary care clinic.
Engagement in treatment and heavy alcohol consumption.
The ACM condition had a significantly higher proportion of participants engaged in treatment over the 26 weeks [OR = 5.36, 95 % CI = (2.99, 9.59)]. The percentage of heavy drinking days were significantly lower in the ACM condition [OR = 2.16, 95 % CI = (1.27, 3.66)], while overall abstinence did not differ between groups.
Results demonstrate that treatment for an alcohol use disorder can be delivered effectively within primary care, leading to greater rates of engagement in treatment and greater reductions in heavy drinking.
- Murray C, Lopez A. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. In: Murray C, Lopez A, eds. The global burden of disease and injury series, Vol. 1. Boston: Harvard University Press; 1996.
- Cohen E, et al. Alcohol treatment utilization: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend. 2007;86(2–3):214–21. CrossRef
- Substance Abuse and Mental Health Services Administration, O.o.A.S., Treatment Episode Data Set (TEDS): 2005. Discharges from substance abuse treatment services. Rockville, MD: U.S. Department of Health and Human Services; 2008.
- U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004;140:554–6.
- Poikolainen K. Effectiveness of brief interventions to reduce alcohol intake in primary health care populations: a meta-analysis. Prev Med. 1999;28:503–9. CrossRef
- Moyer A, et al. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction. 2002;97:279–92. CrossRef
- Babor TF, et al. Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007;28(3):7–30. CrossRef
- Maust DT, et al. Missed opportunities: fewer service referrals after positive alcohol misuse screens in VA primary care. Psychiatr Serv. 2011;62(3):310–2. CrossRef
- Harris AH, et al. Pharmacotherapy of alcohol use disorders by the Veterans Health Administration: patterns of receipt and persistence. Psychiatr Serv. 2012;63(7):679–85. CrossRef
- Kivlahan DR. Outcomes from AUDIT screen throughout the VA system., D. Oslin, Editor 2013.
- Willenbring ML, Olson DH. A randomized trial of integrated outpatient treatment for medically ill alcoholic men. Arch Intern Med. 1999;159(16):1946–52. CrossRef
- O’Connor PG, et al. A preliminary investigation of the management of alcohol dependence with naltrexone by primary care providers. Am J Med. 1997;103(6):477–82. CrossRef
- Lee JD, et al. Extended-release naltrexone for treatment of alcohol dependence in primary care. J Subst Abus Treat. 2010;39(1):14–21. CrossRef
- Kiefer F, et al. Pharmacological relapse prevention of alcoholism: clinical predictors of outcome. Eur Addict Res. 2005;11(2):83–91. CrossRef
- Garbutt J, et al. Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. J Am Med Inform Assoc. 2005;293:1617–25.
- Maisel NC, et al. Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful? Addiction. 2013;108(2):275–93. CrossRef
- Srisurapanont M, Jarusuraisin N. Naltrexone for the treatment of alcoholism: a meta-analysis of randomized controlled trials. Int J Neuropsychopharmacol. 2005;8:1–14.
- Bouza C, et al. Efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence: a systematic review. Addiction. 2004;99(7):811–28. CrossRef
- Oslin D, ed. Foundations for Integrated Care. Department of Veterans Affairs; 2013.
- Bradley KA, et al. The AUDIT alcohol consumption questions: reliability, validity, and responsiveness to change in older male primary care patients. Alcohol Clin Exp Res. 1842;22(8):1842–9.
- Tew J, Klaus J, Oslin DW. The Behavioral Health Laboratory: building a stronger foundation for the patient-centered medical home. Fam Syst Health. 2010;28(2):130–45. CrossRef
- Pettinati H, et al. Medical management treatment manual: a clinical research guide for medically trained clinicians providing pharmacotherapy as part of the treatment for alcohol dependence 2004. Bethesda, MD: NIAAA, DHHS Publication # 04-5289.
- Sobell L, et al. Reliability of a timeline method: assessing normal drinkers’ reports of recent drinking and a comparative evaluation across several populations. Br J Addict. 1988;83:393–402. CrossRef
- Sobell LC, Sobell MB. Timeline follow-back: a technique for assessing self-reported alcohol consumption. In: Litten R, Allen J, eds. Measuring alcohol consumption. Totowa, NJ: Humana Press Inc; 1992:41–65. CrossRef
- Anton R. New methodologies for pharmacological treatment trials for alcohol dependence. Alcohol Clin Exp Res. 1996;20:3A–9. CrossRef
- Volpicelli JR, et al. Naltrexone in the treatment of alcohol dependence.[see comment]. Arch Gen Psychiatry. 1992;49(11):876–80. CrossRef
- Kranzler HR, et al. Efficacy of naltrexone and acamprosate for alcoholism treatment: a meta-analysis. Alcohol Clin Exp Res. 2001;25(9):1335–41. CrossRef
- Miller W, Tonigan J, Longabaugh R. The Drinker Inventory of Consequences (DrInC): an instrument for assessing adverse consequences of alcohol abuse. Vol. Vol. 4. Washington, D.C: U.S. Government Printing Office; 1995.
- Biener L, Abrams DB. The Contemplation Ladder: validation of a measure of readiness to consider smoking cessation. Health Psychol. 1991;10(5):360–5. CrossRef
- Ware J, Kosinski M, Keller S. A 12-item Short-form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;32:220–33. CrossRef
- Diggle P, et al. Analysis of longitudinal data. 2nd ed. Oxford Statistical Science Series #252002, New York: Oxford University Press Inc.
- Molenberghs G, Verbeke G. Models for discrete longitudinal data. Statistics2005: Springer.
- Verbeke G, MG. Linear mixed models for longitudinal data. Statistics2000: Springer.
- A Randomized Clinical Trial of Alcohol Care Management Delivered in Department of Veterans Affairs Primary Care Clinics Versus Specialty Addiction Treatment
Journal of General Internal Medicine
Volume 29, Issue 1 , pp 162-168
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- primary care
- randomized clinical trial
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- Author Affiliations
- 1. Mental Illness Research, Education and Clinical Center at the Philadelphia VA Medical Center, University of Pennsylvania, Philadelphia, PA, 19104, USA
- 2. Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- 3. Department of Psychology, Syracuse University, Syracuse, NY, USA
- 4. Center for Integrated Healthcare, Department of Veterans Affairs, VISN2, Syracuse, NY, USA
- 5. Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA