Effectiveness of community psychosocial and pharmacological treatments for alcohol use disorder: A national observational cohort study in England

Amy Peacock, Brian Eastwood, Andrew Jones, Tim Millar, Patrick Horgan, Jonathan Knight, Kulvir Randhawa, Martin White, John Marsden*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)

Abstract

Background: This was a national English observational cohort study using administrative data to estimate the effectiveness of community pharmacological and psychosocial treatment for alcohol use disorder (AUD). Methods: All adults commencing AUD treatment in the community reported to the National Drug Treatment Monitoring System (April 1 2014–March 31 2015; N = 52,499). Past 28-day admission drinking pattern included drinks per drinking day (DDD): 0 (‘Abstinent’), 1–15 (‘Low-High’), 16–30 (‘High-Extreme’) and over 30 DDD (‘Extreme’). The primary outcome was successful completion of treatment within 12 months of commencement with no re-presentation (SCNR) in the subsequent six months, analysed by multi-level, mixed effects, multivariable logistic regression. Results: The majority reported DDD in the ‘Low-High’ (n = 17,698, 34%) and ‘High-Extreme’ (n = 21,383, 41%) range. Smaller proportions were categorised ‘Extreme’ (n = 7759, 15%) and ‘Abstinent’ (n = 5661, 11%). Three-fifths (58%) achieved SCNR. Predictors of SCNR were older age, black/minority ethnic group, employment, criminal justice system referral, and longer treatment exposure. Predictors of negative outcome were AUD treatment history, lower socio-economic status, housing problems, and ‘Extreme’ drinking at admission. In addition to psychosocial interventions, pharmacological interventions and recovery support increased the likelihood of SCNR. Pharmacological treatment was only beneficial for the ‘Low-High’ groups with recovery support. Conclusions: Over half of all patients admitted for community AUD treatment in England are reported to successfully complete treatment within 12 months and are not re-admitted for further treatment in the following 6 months. Study findings underscore efforts to tailor AUD treatment to the severity of alcohol consumption and using recovery support.

Original languageEnglish
Pages (from-to)60-67
Number of pages8
JournalDrug and Alcohol Dependence
Volume186
DOIs
Publication statusPublished - 1 May 2018

Bibliographical note

Funding Information:
A.P. is supported by a National Health and Medical Research Council Early Career Fellowship (# APP1109366 ). A.P. works at the National Drug and Alcohol Research Centre, which is funded by the Australian Government as part of the National Drug Strategy. She has received untied educational grants from Mundipharma and Seqirus for post-marketing surveillance of pharmaceutical opioid formulations. Alongside his part-time university PhD status, B.E. is employed full-time at Public Health England on the team with responsibility for the National Drug Treatment Monitoring System, from which data for the current paper are extracted. J.M. works in an integrated university and National Health Service academic health sciences centre (Institute of Psychiatry, Psychology and Neuroscience [IoPPN], King’s College London and King’s Health Partners). He is supported by research grants from the Department of Health, Institute for Health Research (NIHR) , and the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Mental Health Foundation Trust (SLaM MHFT) and has part-time employment as Senior Academic Advisor for the Alcohol, Drugs and Tobacco Division, Health and Wellbeing Directorate, Public Health England. He declares untied educational grant funding from the pharmaceutical industry at IoPPN and SLaM MHFT for a study of psychological interventions in opioid maintenance ( 2010-2016 ; Indivior PLC via Action on Addiction). In the past three years he has received honoraria from Merck Serono in 2015 (clinical oncology medicine) and from Indivior via PCM Scientific in relation to the Improving Outcomes in Treatment of Opioid Dependence conference (co-chair, 2015; 2016; chair: 2017). He holds no stocks in any company. All other authors have no disclosures in relation to this article.

Funding Information:
The study was supported by the Alcohol, Drugs and Tobacco Division, Health Improvement Directorate, Public Health England . The contents of this article do not necessarily reflect the views or stated position of PHE.

Publisher Copyright:
© 2018

Keywords

  • Alcohol
  • Alcohol use disorder
  • Pharmacological
  • Psychosocial
  • Recovery
  • Treatment

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