Predictors of Pretreatment Commitment to Abstinence: Results from the COMBINE Study

DeMartini, Kelly S.; Devine, Eric; DiClemente, Carlo C.; Martin, Daniel J.; Ray, Lara A.; O’Malley, Stephanie S.

doi:10.15288/jsad.2014.75.438

Cited by 38 publications

(27 citation statements)

References 43 publications

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“…In particular, some individuals with high self-efficacy and low physical dependence wish to reduce the high risks associated with heavy drinking, but wish to continue to drink moderately and avoid treatment programs that require abstinence (Marlatt and Witkiewitz, 2002). Indeed, studies have shown that preference for controlled-drinking treatment goals over abstinence range between 25.95% to 86.9% of treatment seekers (e.g., DeMartini et al, 2014; Engasser et al, 2015; Heather et al, 2010). …”

Section: Discussionmentioning

confidence: 99%

Transdermal alcohol concentration data collected during a contingency management program to reduce at-risk drinking

Dougherty

Karns

Mullen

et al. 2015

Drug and Alcohol Dependence

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Background Recently, we demonstrated that transdermal alcohol monitors could be used in a contingency management procedure to reduce problematic drinking; the frequency of self-reported heavy/moderate drinking days decreased and days of no to low drinking increased. These effects persisted for three months after intervention. In the current report, we used the transdermal alcohol concentration (TAC) data collected prior to and during the contingency management procedure to provide a detailed characterization of objectively measured alcohol use. Methods Drinkers (n = 80) who frequently engaged in risky drinking behaviors were recruited and participated in three study phases: a 4-week Observation phase where participants drank as usual; a 12-week Contingency Management phase where participants received $50 each week when TAC did not exceed 0.03 g/dl; and a 3-month Follow-up phase where self-reported alcohol consumption was monitored. Transdermal monitors were worn during the first two phases, where each week they recived $105 for visiting the clinic and wearing the monitor. Outcomes focused on using TAC data to objectively characterize drinking and were used to classify drinking levels as either no, low, moderate, or heavy drinking as a function of weeks and day of week. Results Compared to the Observation phase, TAC data indicated that episodes of heavy drinking days during the Contingency Management phase were reduced and episodes of no drinking and low to moderate drinking increased. Conclusions These results lend further support for linking transdermal alcohol monitoring with contingency management interventions. Collectively, studies to date indicate that interventions like these may be useful for both abstinence and moderation-based programs.

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Section: Discussionmentioning

confidence: 99%

Transdermal alcohol concentration data collected during a contingency management program to reduce at-risk drinking

Dougherty

Karns

Mullen

et al. 2015

Drug and Alcohol Dependence

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“…5 Since 2000, the prevalence of binge drinking and alcohol disorders increased 28% and 49% in the U.S., 3 but few with alcohol use disorders in the U.S. or Europe receive treatment. 2,3,6,7 Treatments commonly aim for abstinence, 8 but many individuals with alcohol disorders do not accept abstinence goals, 9 at least initially, so drinking-reduction treatments or clinical recommendations may broaden appeal. 10 Further, in addition to psychosocial interventions, medications may broaden interest in treatment by expanding available options.…”

Section: Introductionmentioning

confidence: 99%

Change in non-abstinent WHO drinking risk levels and alcohol dependence: a 3 year follow-up study in the US general population

Hasin

Wall

Witkiewitz

et al. 2017

The Lancet Psychiatry

125

110

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Background Alcohol dependence often goes untreated. Although abstinence is often the aim of alcohol treatment, many drinkers prefer drinking-reduction goals. Therefore, if supported by evidence of benefit, drinking-reduction goals could broaden the appeal of treatment. Regulatory agencies are considering non-abstinent outcomes as clinical trial efficacy indicators, including reduction in the World Health Organization (WHO) drinking risk levels: very high, high, moderate and low, defined in terms of average grams of ethanol per day. Little is known about the relationship between reductions in WHO risk levels and subsequent reduction in the risk for alcohol dependence. Methods In a U.S. national sample, 22 005 drinkers participated in Wave 1 interviews in 2001–2002 and Wave 2 follow-ups 3 years later. Alcohol consumption and alcohol dependence were assessed at both waves. Logistic regression tested the relationship between change in WHO drinking risk levels between Waves 1 and 2, and Wave 2 alcohol dependence. Findings Reductions of 1, 2 or 3 WHO risk levels predicted significantly lower odds of alcohol dependence at Wave 2, particularly among very high and high risk drinkers at Wave 1, and among those with alcohol dependence at Wave 1. Interpretation Results support the use of reductions in WHO drinking risk levels as clinical trial efficacy indicators. Because the levels can readily be translated into average drinks per day using the standard drink equivalents of different countries, the WHO risk levels could also be used internationally to guide treatment goals and clinical recommendations on drinking reduction.

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“…Once again, the lack of standardized methods among clinical trials and between human laboratory studies and clinical trials hinders the translation from human laboratory findings to clinical outcomes. First, although there tends to be less heterogeneity regarding drinking status and treatment-seeking status in clinical trial participants, there are marked differences in AD phenotype and treatment goals that have been shown to alter the effect of medication (Bujarski et al, 2013;DeMartini et al, 2014). For instance, analyses of the COMBINE Study found that a goal of complete abstinence was associated with an increase in percent days abstinent, days to relapse to heavy drinking, and global clinical outcome compared with a goal of conditional abstinence or controlled drinking (Bujarski et al, 2013).…”

Section: Clinical Trialsmentioning

confidence: 99%

Medications development for the treatment of alcohol use disorder: insights into the predictive value of animal and human laboratory models

Yardley

Ray

2016

Addiction Biology

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Development of effective treatments for alcohol use disorder (AUD) represents an important public health goal. This review provides a summary of completed preclinical and clinical studies testing pharmacotherapies for treatment of AUD. We discuss opportunities for improving the translation from preclinical findings to clinical trial outcomes, focusing on the validity and predictive value of animal and human laboratory models of AUD. Specifically, while preclinical studies of medications development have offered important insights into the neurobiology of the disorder and alcohol's molecular targets, limitations include the lack of standardized methods and streamlined processes whereby animal studies can readily inform human studies. Behavioral pharmacology studies provide a less expensive and valuable opportunity to assess the feasibility of a pharmacotherapy prior to initiating larger scale clinical trials by providing insights into the mechanism of the drug, which can then inform recruitment, analyses, and assessments. Summary tables are provided to illustrate the wide range of preclinical, human laboratory, and clinical studies of medications development for alcoholism. Taken together, this review highlights the challenges associated with animal paradigms, human laboratory studies and clinical trials with the overarching goal of advancing treatment development and highlighting opportunities to bridge the gap between preclinical and clinical research.

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Predictors of Pretreatment Commitment to Abstinence: Results from the COMBINE Study

Cited by 38 publications

References 43 publications

Transdermal alcohol concentration data collected during a contingency management program to reduce at-risk drinking

Transdermal alcohol concentration data collected during a contingency management program to reduce at-risk drinking

Change in non-abstinent WHO drinking risk levels and alcohol dependence: a 3 year follow-up study in the US general population

Medications development for the treatment of alcohol use disorder: insights into the predictive value of animal and human laboratory models

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