A randomized controlled study of exposure therapy as aftercare for alcohol use disorder: study protocol


Background:
It is well documented that individuals with Alcohol Use Disorder (AUD) respond well during evidence-based psychological treatment, but also that a large proportion relapses when discharged from treatment and confronted with alcohol in real life. Cue Exposure Treatment (CET) focuses on exposing individuals to alcohol cues in order to reduce cravings as well as the likelihood of relapse.

The aims of the study are:
1) to investigate whether CET aftercare delivered via a smartphone or in group sessions increases the effect of Cognitive Behavioural Treatment in groups of alcohol dependent individuals; 2) to investigate whether CET as a smartphone application is as or more effective than CET group therapy, and 3) to investigate whether CET as a smartphone application is more cost-effective than CET group aftercare and Aftercare as Usual.

Design and methods:
The study will be implemented as an investigator-blinded randomized controlled trial. A total of 300 consecutively enrolled alcohol use disorder individuals recruited from an alcohol outpatient clinic will be randomized into one of the three following aftercare groups after concluding primary treatment: (1) CET as a smartphone application; (2) CET as group therapy, and (3) Aftercare as Usual. It is hypothesized that the two experimental groups will achieve better treatment outcomes compared to the control group (3).

Discussion:
Individuals in the CET groups are given the opportunity to practise coping strategies during exposure to alcohol stimuli before being unavoidably confronted with alcohol and associated stimuli in real life. Thus, CET may help prevent patients from relapsing after concluding treatment, and in the long term. Moreover, the CET application has the potential to improve AUD treatment and continuing care by offering psychological treatment whenever and wherever the patient finds it convenient.

Trial registration:
ClinicalTrials.gov ID: NCT02298751

Registration date:
6 November 2014

Keywords:
Aftercare, Alcohol use disorder, Cognitive behavioural treatment, Cue exposure treatment, Smartphone application


Autoři: Angelina Isabella Mellentin 1,2,4*;  Bent Nielsen 1,2;  Anette Søgaard Nielsen 1;  Fei Yu 3;  Elsebeth Stenager 1
Působiště autorů: Unit of Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark. 1;  Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 2;  Innovation and Business Research Unit, Mads Clausen Institutet, University of Southern Denmark, Sønderborg, Denmark. 3;  Unit of Psychiatric Research, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense, Denmark. 4
Vyšlo v časopise: BMC Psychiatry 2016, 16:112
Kategorie: Study protocol
prolekare.web.journal.doi_sk: https://doi.org/10.1186/s12888-016-0795-8

© 2016 Mellentin et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. The electronic version of this article is the complete one and can be found online at: http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0795-8

Souhrn

Background:
It is well documented that individuals with Alcohol Use Disorder (AUD) respond well during evidence-based psychological treatment, but also that a large proportion relapses when discharged from treatment and confronted with alcohol in real life. Cue Exposure Treatment (CET) focuses on exposing individuals to alcohol cues in order to reduce cravings as well as the likelihood of relapse.

The aims of the study are:
1) to investigate whether CET aftercare delivered via a smartphone or in group sessions increases the effect of Cognitive Behavioural Treatment in groups of alcohol dependent individuals; 2) to investigate whether CET as a smartphone application is as or more effective than CET group therapy, and 3) to investigate whether CET as a smartphone application is more cost-effective than CET group aftercare and Aftercare as Usual.

Design and methods:
The study will be implemented as an investigator-blinded randomized controlled trial. A total of 300 consecutively enrolled alcohol use disorder individuals recruited from an alcohol outpatient clinic will be randomized into one of the three following aftercare groups after concluding primary treatment: (1) CET as a smartphone application; (2) CET as group therapy, and (3) Aftercare as Usual. It is hypothesized that the two experimental groups will achieve better treatment outcomes compared to the control group (3).

Discussion:
Individuals in the CET groups are given the opportunity to practise coping strategies during exposure to alcohol stimuli before being unavoidably confronted with alcohol and associated stimuli in real life. Thus, CET may help prevent patients from relapsing after concluding treatment, and in the long term. Moreover, the CET application has the potential to improve AUD treatment and continuing care by offering psychological treatment whenever and wherever the patient finds it convenient.

Trial registration:
ClinicalTrials.gov ID: NCT02298751

Registration date:
6 November 2014

Keywords:
Aftercare, Alcohol use disorder, Cognitive behavioural treatment, Cue exposure treatment, Smartphone application


Zdroje

1. Juel K, Sørensen J, Brønnum-Hansen H. Risikofaktorer og folkesundhed i Danmark. Syddansk Universitet: Statens Institut for Folkesundhed; 2006.

2. Hallford H, Tivis RD, Nixon SJ. An empirical assessment of post-treatment alcohol consumption. Psychiatry Res. 2003;121(2):197–205.

3. Witkiewitz K. Lapses following alcohol treatment: modeling the falls from the wagon. J Stud Alcohol Drugs. 2008;69(4):594.

4. Dawe S et al. Efficacy of moderation-oriented cue exposure for problem drinkers: A randomized controlled trial. J Consult Clin Psychol. 2002;70(4):1045.

5. Heather N et al. A randomized controlled trial of moderation-oriented cue exposure. J Stud Alcohol Drugs. 2000;61(4):561.

6. Sitharthan T et al. Cue exposure in moderation drinking: a comparison with cognitive-behavior therapy. J Consult Clin Psychol. 1997;65(5):878–82.

7. Kavanagh DJ et al. Addition of cue exposure to cognitive‐behaviour therapy for alcohol misuse: a randomized trial with dysphoric drinkers. Addiction. 2006;101(8):1106–16.

8. Loeber S et al. Cue exposure in the treatment of alcohol dependence: Effects on drinking outcome, craving and self‐efficacy. Br J Clin Psychol. 2006;45(4):515–29.

9. Kazdin AE, Blase SL. Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspect Psychol Sci. 2011;6(1):21–37.

10. Monti PM et al. Naltrexone and cue exposure with coping and communication skills training for alcoholics: treatment process and 1‐year outcomes. Alcohol Clin Exp Res. 2001;25(11):1634–47.

11. Luxton DD et al. mHealth for mental health: Integrating smartphone technology in behavioral healthcare. Prof Psychol Res Pract. 2011;42(6):505.

12. Donker T et al. Smartphones for smarter delivery of mental health programs: a systematic review. J Med Internet Res. 2013;15(11):e247.

13. Noone M, Dua J, Markham R. Stress, cognitive factors, and coping resources as predictors of relapse in alcoholics. Addict Behav. 1999;24(5):687–93.

14. Monti PM. Treating alcohol dependence: A coping skills training guide. Guilford Press. 2002.

15. Dolan SL et al. Urge-specific and lifestyle coping strategies of alcoholics: Relationships of specific strategies to treatment outcome. Drug Alcohol Depend. 2013;128(1):8–14.

16. Rohsenow DJ et al. Cue exposure with coping skills training and communication skills training for alcohol dependence: 6‐and 12‐month outcomes. Addiction. 2001;96(8):1161–74.

17. Monti PM et al. Cue exposure with coping skills treatment for male alcoholics: a preliminary investigation. J Consult Clin Psychol. 1993;61(6):1011.

18. Lynge E, Sandegaard JL, Rebolj M. The Danish national patient register. Scand J Public Health. 2011;39(7 suppl):30–3.

19. Andersen JS, Olivarius Nde F, Krasnik A. The Danish National Health Service Register. Scand J Public Health. 2011;39(7 Suppl):34–7.

20. Kildemoes HW, Sørensen HT, Hallas J. The Danish national prescription registry. Scand J Public Health. 2011;39(7 suppl):38–41.

21. Mors O, Perto GP, Mortensen PB. The Danish psychiatric central research register. Scand J Public Health. 2011;39(7 suppl):54–7.

22. OECD, OECD. A System of Health Accounts. 2000. http://www.oecd.org/health/health-systems/21160591.pdf.

23. Conklin CA, Tiffany ST. Applying extinction research and theory to cueexposure addiction treatments. Addiction. 2002;97(2):155–67.

24. Martin T, LaRowe S, Malcolm R. Progress in cue exposure therapy for the treatment of addictive disorders: a review update. Open Addict J. 2010;3:92–101.

25. Drummond DC, Glautier S. A controlled trial of cue exposure treatment in alcohol dependence. J Consult Clin Psychol. 1994;62(4):809.

26. Sobell MB et al. Developing a prototype for evaluating alcohol treatment effectiveness, Evaluating alcohol and drug abuse treatment effectiveness: Recent advances. 1980. p. 129–50.

27. McLellan AT et al. The fifth edition of the Addiction Severity Index. J Subst Abus Treat. 1992;9(3):199–213.

28. Love A, James D, Willner P. A comparison of two alcohol craving questionnaires. Addiction. 1998;93(7):1091–102.

29. Anton RF. Obsessive–compulsive aspects of craving: Development of the obsessive compulsive drinking scale. Addiction. 2000;95(8s2):211–7.

30. Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990;13(4):227–36.

31. DiClemente CC et al. The alcohol abstinence self-efficacy scale. J Stud Alcohol Drugs. 1994;55(2):141.

Štítky
Psychiatria
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa