Combining Medical Treatment and CBT in Alcohol-Dependence
Combining Medical Treatment and CBT in Alcohol-Dependence
At Week 12, the mean age of the withdrawn participants was 39.4 years (+7.3), and for those individuals who completed the study, the mean age was 44.2 years (+8.6). At Week 12, the age difference between the dropouts and completers was 4.8 years (P < 0.001), and at Week 52, it was 2.5 years (P = 0.023). The difference in keeping a drinking diary between the dropouts and the completers was statistically significant (P < 0.001).
All three study groups showed a significant reduction in drinking from baseline to the end of the study (Fig. 1). Treatment with disulfiram was more effective than acamprosate or naltrexone in reducing heavy drinking and average weekly alcohol consumption, and in increasing time to the first drink, as well as the number of abstinent days. AUDIT and SADD scores indicated significant reductions (P < 0.0001) in severity of the alcohol problem and in alcohol dependence.
(Enlarge Image)
Figure 1.
Number of drinks per week at the baseline and at the follow-up, 0–119 weeks. (Disulfiram, DIS; naltrexone, NAL; acamprosate, ACA). During the continuous medication period (1–12 weeks), disulfiram was significantly better to reduce drinking than naltrexone and acamprosate (P < 0.0001) and in targeted medication period (13–52 weeks) DIS>NTX (P = 0.0015) and ACA (P = 0.029). The average alcohol consumption in all groups remained significantly below the baseline (P < 0.0001).
The improvement in the QL scores (VAS, KQL and total EQ-5D) over the whole study period (52 weeks and follow-up) was statistically significant (P < 0.0001) with no differences between the groups. EQ-5D QL scales are shown in Table 1, Table 2, Table 3, Table 4 and Table 5. When evaluating self-care, there were no significant differences between medical groups and time. When compared with the first visit values, there were significant positive changes in sleeping, action, pain and mood (Table 2, Table 3, Table 4 and Table 5). Those participants whose initial EQ-5D was poor also had a poorer prognosis.
Both of the depression scales, BDI and DEPS, showed that depression scores decreased significantly (P < 0.0001) during the whole study period when compared with the first visit (Table 6 and Table 7). However, significant differences were not found between medical groups. In the beginning of the study, 23% of the patients used antidepressants, but their use was not recorded at the end of the study.
A significant reduction in the proportion of patients who reported smoking was seen in the disulfiram group during the first 26 weeks (from 55.7 to 35.1%) and again at 52 weeks (from 55.7 to 34.3%) (compared with naltrexone P < 0.001 or acamprosate P < 0.02). No such drop was seen in the naltrexone or acamprosate groups (Table 8). Logistic regression model revealed that using disulfiram had a statistically significant effect on smoking at treatment Week 52 (P-value 0.008). At treatment Week 52, naltrexone and acamprosate users were three times more likely to smoke compared with the disulfiram users (OR = 3.06). Including patients' alcohol consumption during the last 10 weeks in the model did not have a confounding effect on the results.
Results
Study Participation and Dropout
At Week 12, the mean age of the withdrawn participants was 39.4 years (+7.3), and for those individuals who completed the study, the mean age was 44.2 years (+8.6). At Week 12, the age difference between the dropouts and completers was 4.8 years (P < 0.001), and at Week 52, it was 2.5 years (P = 0.023). The difference in keeping a drinking diary between the dropouts and the completers was statistically significant (P < 0.001).
Drinking Outcomes
All three study groups showed a significant reduction in drinking from baseline to the end of the study (Fig. 1). Treatment with disulfiram was more effective than acamprosate or naltrexone in reducing heavy drinking and average weekly alcohol consumption, and in increasing time to the first drink, as well as the number of abstinent days. AUDIT and SADD scores indicated significant reductions (P < 0.0001) in severity of the alcohol problem and in alcohol dependence.
(Enlarge Image)
Figure 1.
Number of drinks per week at the baseline and at the follow-up, 0–119 weeks. (Disulfiram, DIS; naltrexone, NAL; acamprosate, ACA). During the continuous medication period (1–12 weeks), disulfiram was significantly better to reduce drinking than naltrexone and acamprosate (P < 0.0001) and in targeted medication period (13–52 weeks) DIS>NTX (P = 0.0015) and ACA (P = 0.029). The average alcohol consumption in all groups remained significantly below the baseline (P < 0.0001).
Quality of Life
The improvement in the QL scores (VAS, KQL and total EQ-5D) over the whole study period (52 weeks and follow-up) was statistically significant (P < 0.0001) with no differences between the groups. EQ-5D QL scales are shown in Table 1, Table 2, Table 3, Table 4 and Table 5. When evaluating self-care, there were no significant differences between medical groups and time. When compared with the first visit values, there were significant positive changes in sleeping, action, pain and mood (Table 2, Table 3, Table 4 and Table 5). Those participants whose initial EQ-5D was poor also had a poorer prognosis.
Depression
Both of the depression scales, BDI and DEPS, showed that depression scores decreased significantly (P < 0.0001) during the whole study period when compared with the first visit (Table 6 and Table 7). However, significant differences were not found between medical groups. In the beginning of the study, 23% of the patients used antidepressants, but their use was not recorded at the end of the study.
Smoking
A significant reduction in the proportion of patients who reported smoking was seen in the disulfiram group during the first 26 weeks (from 55.7 to 35.1%) and again at 52 weeks (from 55.7 to 34.3%) (compared with naltrexone P < 0.001 or acamprosate P < 0.02). No such drop was seen in the naltrexone or acamprosate groups (Table 8). Logistic regression model revealed that using disulfiram had a statistically significant effect on smoking at treatment Week 52 (P-value 0.008). At treatment Week 52, naltrexone and acamprosate users were three times more likely to smoke compared with the disulfiram users (OR = 3.06). Including patients' alcohol consumption during the last 10 weeks in the model did not have a confounding effect on the results.