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Predictors of abstinence from heavy drinking during treatment in COMBINE and external validation in PREDICT.

ABSTRACT: The goal of the current study was to use tree-based methods (Zhang and Singer, 2010, Recursive Partitioning and Applications, 2nd ed. Springer, New York) to identify predictors of abstinence from heavy drinking in COMBINE (Anton et al. JAMA 2006; 295:2003), the largest study of pharmacotherapy for alcoholism in the United States to date, and to validate these results in PREDICT (Mann et al. Addict Biol 2012; 18:937), a parallel study conducted in Germany.We compared a classification tree constructed according to purely statistical criteria to a tree constructed according to a combination of statistical criteria and clinical considerations for prediction of no heavy drinking during treatment in COMBINE. We considered over 100 baseline predictors. The tree approach was compared to logistic regression. The trees and a deterministic forest identified the most important predictors of no heavy drinking for direct testing in PREDICT.The tree built using both clinical and statistical considerations consisted of 4 splits based on consecutive days of abstinence (CDA) prior to randomization, age, family history of alcoholism, and confidence to resist drinking in response to withdrawal and urges. The tree based on statistical considerations with 4 splits also split on CDA and age but also on gamma-glutamyl transferase level and drinking goal. Deterministic forest identified CDA, age, and drinking goal as the most important predictors. Backward elimination logistic regression among the top 18 predictors identified in the deterministic forest analyses identified only age and CDA as significant main effects. Longer CDA and goal of complete abstinence were associated with better outcomes in both data sets.The most reliable predictors of abstinence from heavy drinking were CDA and drinking goal. Trees provide binary decision rules and straightforward graphical representations for identification of subgroups based on response and may be easier to implement in clinical settings.

SUBMITTER: Gueorguieva R

PROVIDER: S-EPMC4397985 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Predictors of abstinence from heavy drinking during treatment in COMBINE and external validation in PREDICT.

Gueorguieva Ralitza R Wu Ran R O'Connor Patrick G PG Weisner Constance C Fucito Lisa M LM Hoffmann Sabine S Mann Karl K O'Malley Stephanie S SS

Alcoholism, clinical and experimental research 20141001 10

<h4>Background</h4>The goal of the current study was to use tree-based methods (Zhang and Singer, 2010, Recursive Partitioning and Applications, 2nd ed. Springer, New York) to identify predictors of abstinence from heavy drinking in COMBINE (Anton et al. JAMA 2006; 295:2003), the largest study of pharmacotherapy for alcoholism in the United States to date, and to validate these results in PREDICT (Mann et al. Addict Biol 2012; 18:937), a parallel study conducted in Germany.<h4>Methods</h4>We com ...[more]

PMID: 25346505

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Project description:ObjectiveAlcohol use disorder (AUD) is associated with neuroadaptations in brain stress and reward circuits. It is not known whether such neuroadaptations are affected by number of days of alcohol abstinence and whether they influence heavy drinking during the early treatment phase. The authors used a novel functional MRI (fMRI) approach to assess brain responses during sustained exposure to standardized visual stimuli of stressful, alcohol cue, and neutral control images combined with prospective assessment of drinking outcomes during early outpatient treatment, in two related studies.MethodsIn study 1, 44 treatment-entering patients with AUD and 43 demographically matched healthy control subjects participated in the fMRI experiment to identify dysfunctional responses associated with chronic alcohol abuse. In study 2, 69 treatment-entering patients with AUD were assessed for whether fMRI responses at treatment initiation were influenced by alcohol abstinence and were prospectively predictive of early heavy drinking outcomes.ResultsRelative to control subjects, patients with AUD showed significant hyperreactivity in the ventromedial prefrontal cortex (vmPFC) in response to neutral images, but significant hypoactivation in the vmPFC and ventral striatum in response to stress images and to alcohol cues relative to response to neutral images. In study 2, this specific prefrontal-ventral striatal dysfunction was associated with fewer days of alcohol abstinence and also predicted greater number heavy drinking days during the subsequent 2 weeks of treatment engagement.ConclusionsNumber of days of alcohol abstinence at treatment initiation significantly affected functional disruption of the prefrontal-striatal responses to stress images and to alcohol cues in patients with AUD, and the severity of this disruption in turn predicted greater heavy drinking during early treatment. Treatments that target this functional prefrontal-striatal pathology could improve early treatment outcomes in AUD.

Project description:BackgroundTemporary drinking abstinence campaigns have emerged globally in recent years. In Western countries, campaigns usually challenge drinkers to abstain for one month. In Thailand, the campaign called the Buddhist Lent Abstinence Campaign has been organized annually since 2003. The campaign encourages Thai people to abstain from drinking for three months during the Buddhist Lent period, which coincides with the monsoon season in Southeast Asia (around July-October). This study aimed to estimate the proportion and number of drinkers changing their drinking behaviours during the 3-month Thai abstinence campaign and to examine the determinants of abstinence.MethodsThe 2016 Buddhist Lent Abstinence Evaluation Survey was analysed. The survey was a national representative survey of Thai populations aged ≥15 years. Weighted data were employed throughout the analysis. The number and proportion of drinkers changing their drinking behaviours were estimated. The determinants of alcohol abstinence during the campaign were explored using weighted logistic regression.ResultsThe prevalence of drinking in the Thai population was 34.3% (95% CI: 32.2-36.4%). A third of the current drinkers, equal to almost six million drinkers, abstained completely during the 3-month period. Another six million drinkers partially changed their drinking behaviours (16.3% abstained for a certain period, and 18.7% decreased the quantity of alcohol they consumed). The factors associated with abstinence included religion, occupation, drinking frequency prior to the campaign, type of beverages consumed, perceived harm from alcohol, exposure to campaign media, and making a public commitment.ConclusionThis study demonstrated the effectiveness of a temporary abstinence campaign in Thailand. The work is part of the growing global evidence on the effectiveness of this type of intervention. Temporary abstinence campaigns could be a potential approach to controlling alcohol consumption and related harms. Further research should focus on the long-term effects of such campaigns.

Project description:BACKGROUND:Heavy episodic drinking (HED) refers to alcohol consumption that exceeds the recommended threshold for a given episode and increases risk for diverse negative alcohol-related consequences. A pattern of weekly HED is most prevalent in emerging adults (i.e., age 18-25). However, rates of HED consistently decline in the mid to late twenties, referred to as 'aging out' or 'maturing out' of HED. Although many individual studies have followed changes in drinking behaviour over the transition to adulthood, there has yet to be a systematic review to identify consistent factors contributing to risk (i.e. failure to age out) and protection (i.e. successful aging out). The objective of this review will be to summarize and critically appraise the literature on factors contributing to aging out of HED among emerging adults. METHODS:A systematic search of observational cohort studies following drinking behaviours in age cohorts overlapping with the emerging adulthood period will be conducted in MEDLINE, EMBASE, PsychInfo, and CINAHL. Two independent reviewers will evaluate identified studies for inclusion eligibility, extract study data, and assess the quality of included studies. Primary outcomes will be quantity/frequency of alcohol use (e.g. drinks/week) and severity of alcohol-related problems. Predictors of maturing out of HED will be reported narratively, and where appropriate, random effects meta-analyses will be conducted to provide pooled effect sizes. An evidence map will be created to characterize the overall pattern of findings. DISCUSSION:This systematic review will provide a timely and warranted summary of published work contributing to understanding aging out of heavy episodic drinking. Our findings will provide critical commentary on the developmental course of HED during the transition from adolescence to adulthood and will be the first review to consider both protective and risk factors for maturing out of frequent binge drinking. By highlighting factors identifying those at-risk for prolonged heavy episodic drinking, our conclusions will have important treatment implications for primary, secondary, and tertiary intervention strategies. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42017078436 .

Project description:BACKGROUND: Cognitive factors associated with drinking behavior such as positive alcohol expectancies, self-efficacy, perception of impaired control over drinking and perception of drinking problems are considered to have a significant influence on treatment effects and outcome in alcohol-dependent patients. However, the development of a rating scale on lack of perception or denial of drinking problems and impaired control over drinking has not been substantial, even though these are important factors in patients under abstinence-oriented treatment as well as participants in self-help groups such as Alcoholics Anonymous (AA). The Drinking-Related Cognitions Scale (DRCS) is a new self-reported rating scale developed to briefly measure cognitive factors associated with drinking behavior in alcohol-dependent patients under abstinence-oriented treatment, including positive alcohol expectancies, abstinence self-efficacy, perception of impaired control over drinking, and perception of drinking problems. Here, we conducted a prospective cohort study to explore the predictive validity of DRCS. METHODS: Participants in this study were 175 middle-aged and elderly Japanese male patients who met the DSM-IV Diagnostic Criteria for Alcohol Dependence. DRCS scores were recorded before and after the inpatient abstinence-oriented treatment program, and treatment outcome was evaluated one year after discharge. RESULTS: Of the 175 participants, 30 were not available for follow-up; thus the number of subjects for analysis in this study was 145. When the total DRCS score and subscale scores were compared before and after inpatient treatment, a significant increase was seen for both scores. Both the total DRCS score and each subscale score were significantly related to total abstinence, percentage of abstinent days, and the first drinking occasion during the one-year post-treatment period. Therefore, good treatment outcome was significantly predicted by low positive alcohol expectancies, high abstinence self-efficacy, high perception level of impaired control over drinking, and high perception level of drinking problems measured by DRCS. CONCLUSIONS: The DRCS was considered to have satisfactory predictive validity, which further supports our previous findings. It was suggested that DRCS is a promising rating scale for evaluating multidimensional cognitive factors associated with drinking behavior in alcohol-dependent patients under abstinence-oriented treatment.

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Predictors of abstinence from heavy drinking during treatment in COMBINE and external validation in PREDICT.

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Predictors of abstinence from heavy drinking during treatment in COMBINE and external validation in PREDICT.

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