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Randomized Controlled Trial
. 2021 Apr:123:108264.
doi: 10.1016/j.jsat.2020.108264. Epub 2020 Dec 26.

An efficacy trial of adaptive interventions for alcohol use disorder

Jon Morgenstern  1 , Alexis Kuerbis  2 , Sijing Shao  3 , Hayley Treloar Padovano  4 , Svetlana Levak  5 , Nehal P Vadhan  6 , Kevin G Lynch  7
Affiliations
Randomized Controlled Trial

An efficacy trial of adaptive interventions for alcohol use disorder

Jon Morgenstern et al. J Subst Abuse Treat. 2021 Apr.

Abstract

Background: Adaptive interventions, sometimes referred to as "stepped care", are those interventions in which the type or dosage of treatment offered to patients is tailored to baseline clinical presentation and then adjusted over time in response to patient progress or lack thereof. Currently, no adaptive brief interventions exist specifically for alcohol use disorder (AUD).

Method: This study used a sequential multiple assignment randomized trial design with 160 individuals with AUD recruited both locally and nationally who had a goal to reduce or abstain from drinking. Participants received brief advice (BA) and then the study reassessed them three weeks later; the study randomized those who did not respond to BA, defined as reducing their drinking to low-risk guidelines, to two session of motivational interviewing (MI) or more BA. The study then reassessed participants at week 8. The study re-randomized nonresponders to receive either MI alone or MI plus behavioral self-control therapy (BSCT), also referred to as coping skills therapy, and evaluated participants at week 13.

Results: Overall, participants receiving any BSCT made the greatest reductions in drinking. Participants who received MI at week 4 and BSCT at week 8 outperformed all other groups.

Conclusion: Findings reveal that prolonged treatment, more sessions, and/or a specific combination of MI and BSCT provided optimal outcomes. Future research should determine whether such an algorithm holds across heterogenous groups of individuals with AUD.

Keywords: Adaptive interventions; Alcohol use disorder; Brief interventions; Treatment algorithms.

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Conflict of interest statement

Conflict of interest: Authors have nothing to declare.

Figures

Figure 1.
Figure 1.
CONSORT diagram of study procedures.
Figure 2.
Figure 2.
Unadjusted means of SSD and HDD at weeks 1 and 4 for responders (N=18) vs. nonresponders (N=133).
Figure 3.
Figure 3.
Unadjusted means of SSD and HDD for week 4 to week 8 for those randomized to motivational interviewing (MI) or additional brief advice (BA Plus).
Figure 4.
Figure 4.
Unadjusted means for SSD and HDD for week 8 to week 13 for those who were re-randomized at week 8 (non-responders). MI=Motivational Interviewing; BSCT=behavioral self-control therapy; BA= Brief Advice Plus.
See this image and copyright information in PMC

References

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