Variety in Alcohol Use Disorder Relapse Definitions: Should the Term “Relapse” Be Abandoned?

Sliedrecht, Wilco; Roozen, Hendrik G.; Waart, Ranne de; Dom, Geert; Witkiewitz, Katie

doi:10.15288/jsad.2022.83.248

Cited by 15 publications

(10 citation statements)

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“…Although these pilot data do not allow for rigorous mediation of other psychiatric or TMS‐based variables, reductions to both anhedonic symptoms and alcohol‐cue reactivity within this sample are notable in the context of relapse, as both are predictors of relapse in veterans with AUD (Nguyen et al., 2020; Padula et al., 2021). We also acknowledge that there is no universally accepted definition of successful treatment outcome in AUD (Sliedrecht et al., 2022); therefore, it is important to consider other criteria for adaptive posttreatment functioning in the evaluation of rTMS efficacy for AUD (Witkiewitz et al., 2020).…”

Section: Discussionmentioning

confidence: 99%

A pilot, randomized clinical trial: Left dorsolateral prefrontal cortex intermittent theta burst stimulation improves treatment outcomes in veterans with alcohol use disorder

Padula,

McCalley,

Tenekedjieva

et al. 2024

Alcohol: Clinical and Experimental Research

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BackgroundTranscranial magnetic stimulation (TMS) offers a promising treatment avenue to modulate brain function in alcohol use disorder (AUD). To the best of our knowledge, this pilot study is the first randomized, double‐blind, sham‐controlled trial to deliver intermittent theta burst stimulation to the left dorsolateral prefrontal cortex (DLPFC) among US veterans with AUD. We hypothesized that 20 sessions of real TMS are tolerable and feasible. As a secondary line of inquiry, we hypothesized that, relative to sham TMS, individuals receiving real TMS would experience greater reductions in 6‐month relapse rates, anhedonia, and alcohol cue‐reactivity.MethodsVeterans (n = 17, one woman) were enrolled in a double‐blind, sham‐controlled trial (2–3 sessions/day; 7–10 days; 600 pulses/session; 20 sessions). Pre‐ and posttreatment assessments included responses to self‐report questionnaires and functional magnetic resonance imaging measures of alcohol cue‐reactivity. Alcohol consumption was assessed for 6 months. Linear mixed‐effects models were constructed to predict posttreatment craving, mood, and cue‐reactivity.ResultsIndividuals who received active iTBS (n = 8) were less likely to relapse within 3 months after treatment than the sham‐treated group (n = 9) (OR = 12.0). Greater reductions in anhedonia were observed following active iTBS (Cohen's d = −0.59), relative to sham (d = −0.25). Alcohol cue‐reactivity was reduced following active iTBS and increased following sham within the left insula (d = −0.19 vs. 0.51), left thalamus (d = −0.28 vs. 0.77), right insula (d = 0.18 vs. 0.52), and right thalamus (d = −0.06 vs. 0.62).ConclusionsRelative to sham, we demonstrate that 20 sessions of real left DLPFC iTBS reduced the likelihood of relapse for at least 3 months. The potential utility of this approach is underscored by observed decreases in anhedonia and alcohol cue‐reactivity—strong predictors of relapse among veterans. These initial data offer a valuable set of effect sizes to inform future clinical trials in this patient population.

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Section: Discussionmentioning

confidence: 99%

A pilot, randomized clinical trial: Left dorsolateral prefrontal cortex intermittent theta burst stimulation improves treatment outcomes in veterans with alcohol use disorder

Padula,

McCalley,

Tenekedjieva

et al. 2024

Alcohol: Clinical and Experimental Research

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“…AUD relapse was conservatively defined as 'any alcohol use' at 6 and 12 months follow-up. This definition has been extensively used in AUD relapse research (Maisto et al 2016;Sliedrecht et al 2022). In addition, we examined !…”

Section: Aud Relapsementioning

confidence: 99%

“…In future research, it would be worthwhile to examine continuous outcome measures, such as percent heavy drinking days or reductions in drinking, as well as non-consumption outcomes such as drinking consequences and wellbeing. Furthermore, it also must be noted, that still no uniform relapse definition exists (Maisto et al 2016;Sliedrecht et al 2022), which makes it difficult to compare research outcomes.…”

Section: Limitationsmentioning

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 concept of “relapse” within the context of AUD has been a focal point of scholarly discussion in recent years, with a growing consensus advocating for a reevaluation of its definition (Moe et al., 2022). The term “relapse” currently encompasses a range of experiences: from any level of alcohol consumption following a period of abstinence to a return to previous levels of heavy drinking days (Sliedrecht et al., 2022).…”

Section: Introductionmentioning

confidence: 99%

Predicting alcohol relapse post‐detoxification: The role of cognitive impairments in alcohol use disorder patients

Teixeira,

Pinheiro,

Pereira

et al. 2024

Alcohol, Clinical and Experimental Research

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BackgroundStudies on early abstinence suggest that cognitive function is significantly reduced in the first year of abstinence, which raises the question of whether it is relevant to early relapse in patients with substance use disorders. This study investigates the extent to which impairments in executive function and memory predict alcohol relapse in patients with alcohol use disorder (AUD). Understanding these relationships is crucial for improving therapeutic approaches to prevent relapse in patients with AUD.MethodsWe selected 116 adult patients (79 male and 37 female) diagnosed with AUD based on DSM‐5 criteria, all of whom were undergoing alcohol detoxification treatment. A comprehensive array of neuropsychological tests was administered to assess global cognition, memory, and executive functions. Patients' alcohol use was monitored monthly during a 6‐month follow‐up period. Logistic regression and Cox regression were used to explore the relationship between cognitive function and the likelihood of alcohol relapse.ResultsImpairments in global cognition, semantic and phonemic fluency, cognitive flexibility, and learning ability during detoxification were significant predictors of relapse in AUD patients, showing similar predictive values at both 3 and 6 months post‐treatment. An abnormal Montreal Cognitive Assessment (MoCA) score increased the risk of relapse by 123% (HR: 2.227), and impairments in both semantic and phonemic fluency each increased the risk by 142% (HR: 2.423). Additionally, abnormal performance on the MoCA, Trail Making Test Part B (TMT‐B), and California Verbal Learning Test (CVLT) was associated with a higher number of drinking days at 3 months (IRR: 3.764; IRR: 2.237; IRR: 2.738, respectively) and abnormal MoCA and TMT‐B scores at 6 months (IRR: 2.451; IRR: 1.859, respectively).ConclusionsThe MoCA test is a valuable tool for predicting relapse risk in AUD patients undergoing detoxification treatment, with similar predictive value for relapse at 3 or 6 months. Learning ability needs to be assessed and their impairments considered in the treatment of AUD patients. Future research should explore strategies for managing patients with impairments in memory and learning ability to enhance treatment effectiveness and prevent relapse.

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Variety in Alcohol Use Disorder Relapse Definitions: Should the Term “Relapse” Be Abandoned?

Cited by 15 publications

References 0 publications

A pilot, randomized clinical trial: Left dorsolateral prefrontal cortex intermittent theta burst stimulation improves treatment outcomes in veterans with alcohol use disorder

A pilot, randomized clinical trial: Left dorsolateral prefrontal cortex intermittent theta burst stimulation improves treatment outcomes in veterans with alcohol use disorder

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

Predicting alcohol relapse post‐detoxification: The role of cognitive impairments in alcohol use disorder patients

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