The correlates and extent of prescribing of medications for alcohol relapse prevention in England

Donoghue, Kim

doi:10.1111/add.15502

Cited by 11 publications

(9 citation statements)

References 34 publications

(47 reference statements)

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“…Furthermore, we found novel evidence that supports the use of baclofen in preventing liver disease in patients with AUD. Given the well-recognized underuse of medical addiction therapy for patients with AUD, we believe the results of this study highlight the importance of medical addiction therapy in the setting of ALD.…”

Section: Discussionmentioning

confidence: 79%

Incidence and Progression of Alcohol-Associated Liver Disease After Medical Therapy for Alcohol Use Disorder

et al. 2022

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IMPORTANCE Alcohol-associated liver disease (ALD) is one of the most devastating complications of alcohol use disorder (AUD), an increasingly prevalent condition. Medical addiction therapy for AUD may play a role in protecting against the development and progression of ALD. OBJECTIVE To ascertain whether medical addiction therapy was associated with an altered risk of developing ALD in patients with AUD. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used the Mass General Brigham Biobank, an ongoing research initiative that had recruited 127 480 patients between its start in 2010 and August 17, 2021, when data for the present study were retrieved. The mean follow-up duration from AUD diagnosis was 9.2 years. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes were used to identify ALD and AUD diagnoses. EXPOSURES Medical addiction therapy was defined as the documented use of disulfiram, acamprosate, naltrexone, gabapentin, topiramate, or baclofen. Patients were considered to be treated if they initiated medical addiction therapy before the relevant outcome. MAIN OUTCOMES AND MEASURES Adjusted odds ratios (aORs) for the development of ALD and hepatic decompensation were calculated and adjusted for multiple risk factors. RESULTSThe cohort comprised 9635 patients with AUD, of whom 5821 were male individuals (60.4%), and the mean (SD) age was 54.8 (16.5) years. A total of 1135 patients (11.8%) had ALD and 3906 patients (40.5%) were treated with medical addiction therapy. In multivariable analyses, medical addiction therapy for AUD was associated with decreased incidence of ALD (aOR, 0.37; 95% CI, 0.31-0.43; P < .001). This association was evident for naltrexone (aOR, 0.67; 95% CI, 0.46-0.95; P = .03), gabapentin (aOR, 0.36; 95% CI, 0.30-0.43; P < .001), topiramate (aOR, 0.47; 95% CI, 0.32-0.66; P < .001), and baclofen (aOR, 0.57; 95% CI, 0.36-0.88; P = .01). In addition, pharmacotherapy for AUD was associated with lower incidence of hepatic decompensation in patients with cirrhosis (aOR, 0.35; 95% CI, 0.23-0.53, P < .001), including naltrexone (aOR, 0.27; 95% CI, 0.10-0.64; P = .005) and gabapentin (aOR, 0.36; 95% CI, 0.23-0.56; P < .001). This association persisted even when medical addiction therapy was initiated only after the diagnosis of cirrhosis (aOR, 0.41; 95% CI, 0.23-0.71; P = .002). CONCLUSIONS AND RELEVANCEResults of this study showed that receipt of medical addiction therapy for AUD was associated with reduced incidence and progression of ALD. The associations of individual pharmacotherapy with the outcomes of ALD and hepatic decompensation varied widely.

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Section: Discussionmentioning

confidence: 79%

Incidence and Progression of Alcohol-Associated Liver Disease After Medical Therapy for Alcohol Use Disorder

et al. 2022

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“…These tensions and debates are clearly reflected in our interview data, for example, when one clinician talked about their concern that the availability of PrEP would just increase unsafe sex practices which are framed as lacking in personal responsibility. Research also indicates that medications for alcohol relapse prevention are underutilized in England despite NICE guidelines and the evidence-base for their use, and that dispensing ratios can be even lower for socially disadvantaged groups [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

The complexities of integrating evidence-based preventative health into England’s NHS: lessons learnt from the case of PrEP

Khan

Coultas

Kieslich

2023

Health Res Policy Sys

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Background The integration of preventative health services into England’s National Health Service is one of the cornerstones of current health policy. This integration is primarily envisaged through the removal of legislation that blocks collaborations between NHS organisations, local government, and community groups. Aims and objectives This paper aims to illustrate why these actions are insufficient through the case study of the PrEP judicial review. Methods Through an interview study with 15 HIV experts (commissioners, activists, clinicians, and national health body representatives), we explore the means by which the HIV prevention agenda was actively blocked, when NHS England denied responsibility for funding the clinically effective HIV pre-exposure prophylaxis (PrEP) drug in 2016, a case that led to judicial review. We draw on Wu et al.’s (Policy Soc 34:165–171, 2016) conceptual framing of ‘policy capacity’ in undertaking this analysis. Results The analyses highlight three main barriers to collaborating around evidence-based preventative health which indicate three main competence/capability issues in regard to policy capacity: latent stigma of ‘lifestyle conditions’ (individual-analytical capacity); the invisibility of prevention in the fragmented health and social care landscape related to issues of evidence generation and sharing, and public mobilisation (organizational-operational capacity); and institutional politics and distrust (systemic-political capacity). Discussion and conclusion We suggest that the findings hold implications for other ‘lifestyle’ conditions that are tackled through interventions funded by multiple healthcare bodies. We extend the discussion beyond the ‘policy capacity and capabilities’ approach to connect with a wider range of insights from the policy sciences, aimed at considering the range of actions needed for limiting the potential of commissioners to ‘pass the buck’ in regard to evidence-based preventative health.

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“…Several psychological and psychobiological models have been postulated and tested for their validity in predicting relapse (Connors et al 1996;Witkiewitz andMarlatt, 2004, 2007;Hendershot et al 2011;Witkiewitz 2011;Sliedrecht et al 2019), and have generated therapeutic targets to prevent relapse (Donovan and Witkiewitz, 2012;Huebner and Kantor, 2010;Larimer et al 1999). Craving is one of the most prominent targets for interventions (Donovan and Witkiewitz, 2012;Larimer et al 1999) and a limited number of medications (Donoghue et al 2015;Mann et al 2018;Witkiewitz et al 2019;Donoghue 2021) within many treatment settings. 'Craving', as well as other determinants like 'severity of AUD', 'psychiatric comorbidity', 'emotions' and several social and spiritual factors, have been identified as important factors in the achievement of remission or the occurrence of a relapse (Witkiewitz and Marlatt, 2004;Hendershot et al 2011;Sliedrecht et al 2019).…”

Section: Alcohol Use Disorder and Relapsementioning

confidence: 99%

Alcohol use disorder relapse factors: an exploratory investigation of craving, alcohol dependence severity, and meaning in life

Sliedrecht¹,

Seesink²,

Vrijmoeth³

et al. 2022

Addiction Research & Theory

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For decades predictors of alcohol use disorder (AUD) relapse have been studied, and around 40 different clinical and demographic relapse determinants have been identified. This paper aims to investigate the relationship of two of these AUD relapse factors, namely craving and meaning in life (MiL). We hypothesized that greater meaning in life would be associated with lower cravings and lower relapse rates. An AUD subsample of 81 patients within a clinical population that participated in ongoing exploratory research on religious/spiritual factors related to substance use disorders was followed up to 1 year. Craving (as measured with the Penn Alcohol Craving Scale) and meaning in life (as measured with the Meaning in Life Questionnaire-presence subscale) measures were assessed at baseline and relapse was assessed at 6-and 12-month follow up. Main effects and the interaction between craving and meaning in life in predicting alcohol relapse (with relapse defined as 'any alcohol use' and ! 3 consecutive days of drinking) were calculated/subject of analyses. We also investigated the relationship between relapse and alcohol dependence severity as measured with the Leeds Dependence Questionnaire. Baseline craving and dependence severity were related to relapse, but there were no associations between meaning in life and levels of craving or alcohol relapse. Our findings suggest a need for additional research on characterizing the Meaning in Life concept.

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The correlates and extent of prescribing of medications for alcohol relapse prevention in England

Cited by 11 publications

References 34 publications

Incidence and Progression of Alcohol-Associated Liver Disease After Medical Therapy for Alcohol Use Disorder

Incidence and Progression of Alcohol-Associated Liver Disease After Medical Therapy for Alcohol Use Disorder

The complexities of integrating evidence-based preventative health into England’s NHS: lessons learnt from the case of PrEP

Alcohol use disorder relapse factors: an exploratory investigation of craving, alcohol dependence severity, and meaning in life

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