Can Alcohol Dependent Patients Adhere to an ‘As-Needed' Medication Regimen?

Sinclair, Julia; Chick, Jonathan; Sørensen, Per; Kiefer, Falk; Batel, Philippe; Gual, Antoni

doi:10.1159/000357865

Cited by 16 publications

(10 citation statements)

References 30 publications

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“…Harm reduction is a core element of UK drug treatment programmes but its application in specialist alcohol services is disputed ( Luty, 2006 ). Goals of reduced consumption can be beneficial in arresting escalating patterns of drinking ( Ambrogne, 2002 ) and attract and retain individuals who are ambivalent or who would otherwise not seek or participate in therapy ( Heather, 2006 ; Sinclair et al , 2014 ). Such strategies may be beneficial in facilitating early access to services while increasing the self-efficacy of those in the initial stages of treatment.…”

Section: Discussionmentioning

confidence: 99%

Navigating the Alcohol Treatment Pathway: A Qualitative Study from the Service Users' Perspective: Table 1.

Gilburt

Drummond

Sinclair

2015

Alcohol and Alcoholism

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AimsProvision of effective treatment for dependent drinkers has been identified as a priority in England yet evidence suggests that access is problematic and there are low levels of retention. This qualitative study explores how the alcohol treatment system is experienced by service users, identifying barriers and facilitators that influence treatment outcomes.MethodsA total of 20 semi-structured face-to-face interviews were conducted with patients from community alcohol treatment services in three London boroughs in 2012. Interviews were undertaken one year after initially entering treatment. A thematic analysis was conducted, with the results further abstracted to relate them to specific aspects of the treatment journey.ResultsPatients journeys were characterized by a perceived lack of control leading to help-seeking, with treatment outcomes influenced by an individuals' self-efficacy and the capabilities and skills of staff in actively engaging and supporting patients on the journey. A focus of services on the detoxification process and fragmented care pathways impacted negatively on engagement.ConclusionsCurrent alcohol care pathways require significant levels of motivation and self-efficacy to navigate that few patients possess. Pathways need to better reflect the capacity and capabilities of patients to be successful in supporting recovery.

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Section: Discussionmentioning

confidence: 99%

Navigating the Alcohol Treatment Pathway: A Qualitative Study from the Service Users' Perspective: Table 1.

Gilburt

Drummond

Sinclair

2015

Alcohol and Alcoholism

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“…As in the pivotal studies, patients in Cohort-A took nalmefene on about half of the study days. While overall adherence was good (70%), fewer patients were adherent on ≥80% of days than in the pivotal studies (47 vs. 68%) [31].…”

Section: Discussionmentioning

confidence: 80%

Nalmefene, Given as Needed, in the Routine Treatment of Patients with Alcohol Dependence: An Interventional, Open-Label Study in Primary Care

et al. 2018

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Aims: This 12-week, open-label, primary care study (NCT02195817) evaluated the efficacy and safety of nalmefene, taken as needed, to reduce alcohol consumption in adults with a diagnosis of alcohol dependence and drinking at least at high drinking risk levels (DRL, > 60 g/day for men, > 40 g/day for women). Methods: Following the Screening Visit, patients recorded their daily alcohol consumption for 2 weeks. Patients were then categorised by their self-reported drinking levels; those who maintained at least a high DRL in the 2-week period were included in Cohort-A, and those who reduced their alcohol consumption below high DRL were included in Cohort-B. Cohort-A received simple psychosocial interventions and were supplied with nalmefene 18 mg to be taken on days when they perceived a risk of drinking alcohol. Patients in Cohort-B received a simple psychosocial intervention and were treated per normal practice. Results: Of the 378 enrolled patients, 330 were included in Cohort-A and 48 in Cohort-B. For patients in Cohort-A, the mean change from screening to Week-12 in the number of heavy drinking days/month was –13.1 days/month (95% CI –14.4 to –11.9, p < 0.0001). Overall, 55% of patients reduced their DRL by ≥2 risk levels and 44% of patients reduced to a low DRL. The most common adverse events were nausea (18.3%) and dizziness (17.7%). Patients in Cohort-B maintained their lower level alcohol consumption at the 12-week follow-up. Conclusions: Patients with alcohol dependence treated in primary care with nalmefene, taken as needed, in conjunction with simple psychosocial support, significantly reduced their alcohol consumption. Treatment was well tolerated.

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“…Although it has been a standard practice for many years in asthma, diabetic, and allergy care, it represents a paradigm shift in the way that pharmacotherapy is used in the management of alcohol use disorders. 70 …”

Section: Resultsmentioning

confidence: 99%

Patient-centered care interventions for the management of alcohol use disorders: a systematic review of randomized controlled trials

Barrio

Gual

2016

PPA

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IssuesPatient-centered care (PCC) is increasingly accepted as an integral component of good health care, including addiction medicine. However, its implementation has been controversial in people with alcohol use disorders.ApproachA systematic search strategy was devised to find completed randomized controlled trials enrolling adults (>18 years) with alcohol use disorders. Studies had to use a PCC approach such that they should have been individualized, respectful to the patients’ own goals, and empowering. Studies until September 2015 were searched using PubMed, Scopus, the Cochrane Library, PsychINFO, and Web of Knowledge.Key findingsIn total, 40 studies enrolling 16,020 patients met the inclusion criteria. Assessment revealed two main categories of study: psychosocial (n=35 based on motivational interviewing) and pharmacological (n=5 based on an as needed dosing regimen). Psychosocial interventions were further classified according to the presence or absence of an active comparator. When no active comparator was present, studies were classified according to the number of sessions (≥1). Results from single sessions of motivational interviewing showed no clear benefit on alcohol consumption outcomes, with few studies indicating benefit of PCC versus control. Although the results for studies of multiple sessions of counseling were also mixed, many did show a significant benefit of the PCC intervention. By contrast, studies consistently demonstrated a benefit of pharmacologically supported PCC interventions, with most of the differences reaching statistical significance.ImplicationsPCC-based interventions may be beneficial for reducing alcohol consumption in people with alcohol use disorders.

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Can Alcohol Dependent Patients Adhere to an ‘As-Needed' Medication Regimen?

Cited by 16 publications

References 30 publications

Navigating the Alcohol Treatment Pathway: A Qualitative Study from the Service Users' Perspective: Table 1.

Navigating the Alcohol Treatment Pathway: A Qualitative Study from the Service Users' Perspective: Table 1.

Nalmefene, Given as Needed, in the Routine Treatment of Patients with Alcohol Dependence: An Interventional, Open-Label Study in Primary Care

Patient-centered care interventions for the management of alcohol use disorders: a systematic review of randomized controlled trials

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