|Titre :||World Health Organization risk drinking level reductions are associated with improved functioning and are sustained among patients with mild, moderate and severe alcohol dependence in clinical trials in the United States and United Kingdom (2020)|
|Auteurs :||K. WITKIEWITZ ; N. HEATHER ; D. E. FALK ; R. Z. LITTEN ; D. S. HASIN ; H. R. KRANZLER ; K. F. MANN ; S. S. O'MALLEY ; R. F. ANTON|
|Type de document :||Article : Périodique|
|Dans :||Addiction (Vol.115, n°9, September 2020)|
|Article en page(s) :||1668-1680|
|Note générale :||Commentary: WHO risk drinking classification system is promising in clinical trials, but needs to be tested in other patient groups. Berglund K., p. 1681-1682.|
|Discipline :||SAN (Santé publique / Public health)|
Thésaurus TOXIBASEALCOOL ; REPERE DE CONSOMMATION ; DEPENDANCE ; REDUCTION DE CONSOMMATION ; RECOMMANDATION ; ETUDE CLINIQUE ; FACTEUR DE RISQUE ; CONSOMMATION
Thésaurus GéographiqueETATS-UNIS ; ROYAUME-UNI
AIMS: To examine whether World Health Organization (WHO) risk-level reductions in drinking were achievable, associated with improved functioning and maintained over time among patients at varying initial alcohol dependence severity levels.
DESIGN AND SETTING: Secondary data analysis of multi-site randomized clinical trials: the US Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study and the UK Alcohol Treatment Trial (UKATT).
PARTICIPANTS: Individuals with alcohol dependence enrolled in COMBINE (n = 1383; 68.8% male) and seeking treatment for alcohol problems in UKATT (n = 742; 74.1% male). Interventions Naltrexone, acamprosate or placebo, and combined behavioral intervention or medication management in COMBINE. Social behavior network therapy or motivational enhancement therapy in UKATT.
MEASUREMENTS: WHO risk-level reductions were assessed via the calendar method. Alcohol dependence was measured by the Alcohol Dependence Scale, the Leeds Dependence Questionnaire and the Diagnostic and Statistical Manual of Mental Disorders. Measures of functioning included alcohol-related consequences (Drinker Inventory of Consequences and Alcohol Problems Questionnaire), mental health (Short Form Health Survey) and liver enzyme tests.
FINDINGS: One- and two-level reductions in WHO risk levels in the last month of treatment were maintained at the 1-year follow-up [adjusted odds ratio (OR), 95% confidence interval (CI) = one-level reduction in COMBINE: 3.51 (2.73, 4.29) and UKATT: 2.65 (2.32, 2.98)] and associated with fewer alcohol-related consequences [e.g. B, 95% CI = one-level reduction COMBINE: -26.22 (-30.62, -21.82)], better mental health [e.g. B, 95% CI = one-level reduction UKATT: 9.53 (7.36, 11.73)] and improvements in gamma-glutamyltransferase [e.g. B, 95% CI = one-level reduction UKATT: -89.77 (-122.50, -57.04)] at the end of treatment, even among patients with severe alcohol dependence. Results were similar when abstainers were excluded.
CONCLUSIONS: Reductions in World Health Organization risk levels for alcohol consumption appear to be achievable, associated with better functioning and maintained over time in both the United States and the United Kingdom.
|Domaine :||Alcool / Alcohol|
|Refs biblio. :||50|
|Affiliation :||Department of Psychology, University of New Mexico, Albuquerque, NM, USA|