Novel treatments for alcohol dependence: A randomized controlled trial of structured stepped-care intervention for psychiatric comorbidity

Researchers

  1. Professor Paul Haber, University of Sydney & Royal Prince Alfred Hospital, Central Sydney Areas Health Service
  2. Dr Stefanie Leung, University of Sydney
  3. Dr Andrew Baillie, Macquarie University
  4. Dr Claudia Sannibale, University of New South Wales
  5. Professor Maree Teesson, University of New South Wales

Summary

A substantial proportion of the alcohol dependent population also suffer from anxiety or depression. People who are alcohol dependent and suffer psychiatric comorbidity respond poorly to treatment. This study sought to:

  • assess the effectiveness of a novel, stepped-care intervention for alcohol dependent patients with co-morbid anxiety and/or depression with a view to improving treatment outcomes for this important group; and
  • identify important factors relating to the maintenance and treatment of alcohol-related psychiatric co-morbidity including fundamental barriers to treatment response.

A randomised controlled trial was used with two treatment groups – one group received the stepped-care intervention (novel treatment) while the other group received usual care (control group).

Eighty-six alcohol-dependent patients were initially involved in the study.  All participants were prescribed a concurrent 12 week course of anti-craving medication.

After 3 weeks of stabilisation on the study medication, participants underwent a structured interview for anxiety and depression.  In total, 37 participants were diagnosed with a depressive or anxiety disorder and were randomised to the next step of care, with 16 patients in the control group and 21 in the treatment group.

The control group received usual-care including counselling in accord with standard practice at Drug Health Services, Royal Prince Alfred Hospital. This typically comprised brief individualised motivational enhancement therapy (e.g. feedback of assessment findings, reinforcement, empathy and client’s own motivation).

The treatment group received specific Cognitive Behavioural Therapy (CBT) based on the case formulation from the baseline structured interview and was delivered by a doctoral level clinical psychologist.  The intervention used evidence-based principles for treatment of anxiety disorders and depression, and was based on established treatment manuals.  Interventions were delivered in seven to ten sessions.

Outcomes

All participants in the study demonstrated improved drinking and depression/anxiety outcomes as a result of their involvement. However, the patients in the treatment group showed significant resolution of their anxiety, stress and alcohol severity scores compared to the control group. They also attended significantly more appointments over the treatment period and achieved significantly higher rates of abstinence from drinking.

A limitation of this study is that the numbers of patients and controls were relatively small. A larger trial is required to provide more definitive evidence.

Related Resources

Baillie and Sannibale., 2007: Anxiety and drug and alcohol problems. in Baker, Amanda & Velleman, Richard. Clinical handbook of co-existing mental health and drug and alcohol problems. (pp.197-217). New York, NY, US: Routledge/Taylor & Francis Group; US). [This chapter in the handbook outlines the stepped care treatment of alcohol problems and comorbid anxiety (presented as a chapter) that the treating clinicians utilized on the project. The clinical pathway and guiding principles outlined shaped the protocol and directed the psychologists delivering the intervention.]

Baillie Andrew J, Lexine Stapinski, Erica Crome, Kirsten Morley, Claudia Sannibale, Paul Haber, and Maree Teesson. “Some New Directions for Research on Psychological Interventions for Comorbid Anxiety and Substance Use Disorders.” Drug and Alcohol Review 29, no. 5, 2010 , 518-524.

Haber Paul, Leung Stefanie, Baillie Andrew, Sannibale Claudia, Teesson Maree. “Novel Treatments for Alcohol Dependence: A Randomised Controlled Trial of Structured Stepped-Care Intervention for Psychiatric Comorbidity”. Drug and Alcohol Reivew 30, no. 1, November 2011, 37.

Seth D, Proude E, Haber P. Identification of Co-Morbidities Associated with Alcoholic Liver Disease. University of Sydney.

FARE continues to fund and undertake research that contributes to the knowledge-base about alcohol harms and strategies to reduce them.

This research is used to inform our approach to evidence-based alcohol policy development, ensuring that the solutions we are advocating for are informed by research. FARE’s research is also often quoted by governments, other not-for-profit organisations and researchers in public discussions about alcohol, demonstrating that FARE is seen as a leading source of information.

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