drinking habits - self-rating scale (1) i use to drink: 1. when i meet someone 2. when i have some...

39
DRINKING HABITS - Self-rating Scale (1) I use to drink: 1. When I meet someone 2. When I have some trouble, to forget them 3. Out of habit 4. For the taste 5. For the taste which became a habit 6. It's a family habit 7. To pep up 8. In the company of my spouse 9. Because I like to drink 10. When I feel lonely 11. To raise my morale 12. To avoid trembling the day after a bout of heavy drinking 13. For professional reasons 14. When I feel abandoned Each item is rated as: 0 = never 1 = seldom 2 = sometimes 3 = frequently according to the global situation during the last 6 months

Upload: milo-sullivan

Post on 16-Dec-2015

213 views

Category:

Documents


0 download

TRANSCRIPT

DRINKING HABITS - Self-rating Scale (1)I use to drink:

1. When I meet someone

2. When I have some trouble, to forget them

3. Out of habit

4. For the taste

5. For the taste which became a habit

6. It's a family habit

7. To pep up

8. In the company of my spouse

9. Because I like to drink

10. When I feel lonely

11. To raise my morale

12. To avoid trembling the day after a bout of heavy drinking

13. For professional reasons

14. When I feel abandoned

Each item is rated as:0 = never 1 = seldom2 = sometimes 3 = frequentlyaccording to the global situation during the last 6 months

DRINKING HABITS - Self-rating Scale (2)I use to drink:

15. When I have problems which I can't tolerate

16. With a meal

17. When I find myself with a group of drinkers

18. To feel better

19. Before doing something

20. To kill time

21. In the evening to relax

22. To pick me up

23. When I am offered a drink

24. When I feel isolated

25. To be in a good mood when I am with other people

26. When I am bored

27. When I am busy with something

28. When I feel tense, anxious

29. Before meeting someone

Each item is rated as:0 = never 1 = seldom2 = sometimes 3 = frequentlyaccording to the global situation during the last 6 months

DRINKING HABITS - Self-rating Scale (3)I use to drink:

30. When I feel down

31. When I am in a particular surrounding

32. I enjoy drinking

33. To show that I can drink as much or more than anyone

34. To be less anxious, the day after a bout heavy drinking

35. When I am influenced by others to drink

36. When I have to do something unusual

37. To be different from my everyday self

38. Before speaking to certain persons

39. To avoid feeling lousy, the day after a bout of heavy drinking

40. As an escape, to avoid reality

41. To feel more selfassured in certain situations

42. To isolate myself

43. When I feel tired, exhausted

44. After the first drink I can't stop

45. To help me fall asleep at night

Each item is rated as:0 = never 1 = seldom2 = sometimes 3 = frequentlyaccording to the global situation during the last 6 months

MODES OF DRINKING: ALCOHOLISM

1. SOCIAL:in a social setting

2. HABIT:from habit, for the taste

3. STRESS:to escape psychological difficulties

4. PHYSICAL DEPENDENCE:to avoid withdrawal symptoms

5. STIMULUS:as a stimulus for activity, for assertiveness

Each mode is rating on a 4 level scale, validated for timeand interrater reliability:0 = never 2 = sometimes1 = seldom 3 = frequently

ANGER 70 %

This person feels angerThis person feels anger

1 2 3 4 5 6 7Not at allNot at all Very intensivelyVery intensively

INTENSITY SCORES AS FUNCTION OF GROUP AND FACIAL EXPRESSION

Note. * p<.05; ** p<.01 Kornreich et al. (2001) Journal of Studies on Alcohol

Emotional Facial Expressions

0

0,5

1

1,5

2

2,5

3

3,5

4

Happiness Anger Sadness Disgust Fear

Normal Controls

Abstinent Alcoholics

Recently detoxified Alcoholics

*

** **

** **Intensity

scores

9,47(0,53)

8,93 (1,14)

9,33 (0,71)

5,13 (1,62)

0

1

2

3

4

5

6

7

8

9

10

Serial recall Alphabetical RecallCondition

Controls

Alcoholics

*

COMPARISONS BETWEEN PERFORMANCES ON THE SERIAL AND THE ALPHABETICAL

RECALL SCORES ON THE ALPHA-SPAN TEST

Effect of group: F1,58=43.6, p<.001; Effect of condition: F1,58=90.9, p<.001 Interaction between group and condition: F1,58=54.6, p<.001* Post-hoc analysis indicated that ALC performed lower only in alphabetic recall (p<.01)

Score

AVERAGE NUMBER OF ERRORS MADE BY ALCOHOLICS AND CONTROLS

ON THE HAYLING TEST

0,2

4,2

0,23

8

0

1

2

3

4

5

6

7

8

9

Initiation (Section A) Inhibition (Section B)Condition

Controls

Alcoholics

***

Note. *** p<.001

Points

of

penalty

RELATIONSHIP BETWEEN POSITIVE AND NEGATIVE REINFORCEMENT

drug POSITIVE REINFORCEMENTchemical drug reward Glu, GABA, DA/endorphins

drugdrugadapt

adapt CHRONIC DRUG TOLERANCEneurochemical adaptation Glu RS, GABAA Rs, ? DA/Es

drug adapt adaptNEGATIVE REINFORCEMENTexposure of neuronal adaptationearly minor signs of withdrawal

adaptationWITHDRAWAL SIGNSuntil adaptation is removed

DETOXIFICATION IS RELATIVELY EASYDETOXIFICATION IS RELATIVELY EASYMAJOR THERAPEUTIC PROBLEMS BEGIN HEREMAJOR THERAPEUTIC PROBLEMS BEGIN HERE

CONDITIONING OF REINFORCEMENTS = CRAVING?

+ CUE + CUE + CUE

D D D Repeated pairing"conditions"associated stimulus ("cue")

CUE

POSITIVE ASPECTS OF CRAVINGConditioned stimulus (cue) elicits anticipation of drug rewarde.g. relaxation, euphoria, excitement

+ CUE + CUE + CUE

DD

D Cue becomesconditionedstimulus for adaptation

CUE

NEGATIVE ASPECTS OF CRAVINGConditioned stimulus (cue) elicits "pseudo-withdrawal"e.g. anxiety, dysphoria, depression, tremor, etc.

AA

A

A

THE MECHANISMS OF ALCOHOL DEPENDENCE

Adaptation to alcohol as the basis for the Withdrawal SyndromeAdaptation to alcohol as the basis for the Withdrawal Syndrome

Excitation

InhibitionAlcohol administration Withdrawal

Acute effect

Withdrawalsyndrome

Development of tolerance

Littleton JM.Addiction, 1995

Immediate CNS depressant effects of ethanol become limited by neurochemical adaptation

Exposure of adaptation causes hyperexcitation

Campral®: A NOVEL ACTION IN

ALCOHOL DEPENDENCENORMALNORMAL CHRONIC ALCOHOLISMCHRONIC ALCOHOLISM

BALANCE

WITHDRAWALWITHDRAWAL CRAVINGCRAVINGHYPEREXCITATION

BALANCE

Inh Exc Inh Exc

BAR Alc+

Exc BRAIN+

BAR AlcInh

Exc

Exc BRAIN+

Inh

Exc

Exc BRAIN+ (learned

association)

Inh Exc

Campral® + CRAVING BRAIN

(learned association)

EFFECT OF Campral® ON DISRUPTED NEUROTRANSMISSION

Acutealcoholintake

Chronicexposureto alcohol

Adaptation

EAA**Excitatory Amino Acids Glutamate in particular

GABAGABA

GABA +

EAA -

EAA

Campral®

META-ANALYSIS Method of Hedges & Olkin, 1985

Included 15 randomized placebo-controlled, double-Included 15 randomized placebo-controlled, double-blind studiesblind studies

performed in 11 European countriesperformed in 11 European countries involved over 4,400 alcohol-dependent outpatientsinvolved over 4,400 alcohol-dependent outpatients

Confirmed the significant effect of acamprosate versus Confirmed the significant effect of acamprosate versus placebo on abstinence parametersplacebo on abstinence parameters

Supports the generalizability of acamprosate data Supports the generalizability of acamprosate data

0

100

200

300

400

500

600

700

STUDY SIZE

CUMULATIVE ABSTINENCE DURATION PROPORTION

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

Campral

Placebo

*

*

*p < 0.05

**

**

**

*

* *

0

20

40

60

80

100

120

140

160

180

Paille et al, '95

Sass et al, '96

Whitworth et al, '96

Barrias et al, '97

Geerlings et al, '97

Pelc et al, '97

Poldrugo, '97

Chick et al, '00

Tempesta et al, '00

AcamprosatePlacebo

ACAMPROSATE EUROPEAN DOUBLE-BLIND, PLACEBO-CONTROLLED TRIALS

Days to First Drink

ACAMPROSATE EUROPEAN DOUBLE-BLIND, PLACEBO-CONTROLLED TRIALS

Rate of Total Abstinence (%)

0%

10%

20%

30%

40%

50%

60%

Lhuintre et al, '85

Pelc et al, 92

Ladewig et al, '93

Paille et al, '95

Rousseaux et al, '96

Sass et al, '96

Whitworth et al, '96

Barrias et al, '97

Geerlings et al, '97

Pelc et al, '97

Poldrugo, '97

Besson et al, '98

Chick et al, 00

Tempesta et al, '00

Gual et al. '01

Acamprosate

Placebo

Overall Mean %:

Acamprosate = 35.7%

Placebo = 21.9%

D = 13.8%

RESULTS: % ABSTAINERS IN PATIENTS ON TREATMENT

5 TRIALS (TREATMENT DURATION: 12 MONTHS)

0102030405060708090

100

0 30 90 180 270 360

acamprosate placebo%

Days

**

* **

*: p<0,001

40

50

60

70

80

90

100

0 30 90 180 270 360

Acamprosate Placebo

***

**

*: p<0,001

N = 3,338 N = 2,876 N = 958N = 2,262 N = 866N = 1,679

%

Days

ABSTINENCE RATES FOR PATIENTS WHOREMAINED IN THE TRIALS

Percentage of patients abstinent(treatment duration 3-12 months)

0

10

20

30

40

50

60

70

80

90

100

Acamprosate

Placebo

Continuous abstinence: time to first drink

% P

atie

nts

Treatment Period Follow-up Period

Never had a drink

FOLLOW-UP PERIOD(Sass et al.)

600 120 180 240 300 360 420 480 540 660600 720

EFFECT OF CAMPRAL ON ABSTINENCE RATE, CUMULATIVE ABSTINENCE

DURATION, COMPLIANCE TO TREATMENT AND CLINICAL GLOBAL IMPRESSION

0

10

20

30

40

50

60

Acamprosate Placebo

Results after 180 treatment daysPelc IBELGIUM

*

*

*

**

* p<0.05** p<0.005

Abstinence rate CAD Compliance CGI

Days

% P

atie

nts

NEW EUROPEAN ALCOHOLISM TREATMENT (NEAT) ACAMPROSATE PROGRAM

Open label, multicenter, multinational (5)Open label, multicenter, multinational (5) 1 281 alcohol-dependent patients1 281 alcohol-dependent patients 6-month study duration6-month study duration Concurrent group, individual, relapse prevention or Concurrent group, individual, relapse prevention or

brief intervention therapybrief intervention therapy Comparisons of acamprosate efficacy across therapy Comparisons of acamprosate efficacy across therapy

conditions found conditions found significant improvement in all groups in maintaining significant improvement in all groups in maintaining

abstinence and reducing relapse durationabstinence and reducing relapse duration no difference between behavioral therapy groupsno difference between behavioral therapy groups

0 50 100 150 200 250

Group therapy + CAMPRAL

Individual therapy +CAMPRAL

Cognitive therapy + CAMPRAL

Brief intervention + CAMPRAL

Total

Cumulative Abstinence Duration in daysby intervention type (per protocol)

THERE IS NO DIFFERENCE IN CAD BETWEEN DIFFERENT TYPES

OF PSYCHOTHERAPY IN PATIENTS ON Campral®

CONCLUSIONS (1)

Of all patients included

1. HRQoL in markedly reduced in alcoholic patients

2. The greater deficit is related to mental and social functioning

3. QoL at baseline is influenced by severity of alcoholism, health, employment status, age and gender

Of compliant patients

4. Treatment normalised QoL in three months

5. Abstinence and compliance are the best predictor of QoL at study end

CONCLUSIONS (2)

CAD values in the NEAT were similar to those in randomised controlled studies

Acamprosate increases QoL in enhancing abstinence.

Acamprosate

Abstinence

QOL •

Acamprosate Treatment Outcomes

FURTHER QUESTIONS

1. The Role of the Environment

2. The Role of Cognitive Functioning

3. The Time Factor

Role of Social Support - Brief Intervention and Motivational contact on the efficacy of

Acamprosate during the follow-up of detoxified alcoholic patients

Pr I. PELC and collUniversity Hospital Brugmann Université Libre de BruxellesBELGIUM

CAPRISO STUDY

Introduction (1)

Importance of "Supportive Treatment" (Social support Brief intervention-motivational Contact) in the follow-up of alcoholic patients is well documented

Studies combining pharmacotherapy and various psychosocial intervention are more seldom

Differential outcome regarding allocation of patients according to "clinical based experience" (Ansoms and coll, Belgium, 2000) or to "Patient - Treatment matching" (Project Match, USA, 1993) is not conclusive

CAPRISO STUDY

Introduction (2)

Success in implementing a "General helping process" and providing a "General well-being feeling " to the patients during follow-up, seems to be key factors throughout the various psychotherapeutic procedures during follow-up (I. Pelc, 1977 and 1985)

"Although social support has been repeatedly identified as a strong correlate of recovery from alcohol problems, enhancing social support has seldom been a focus of treatment research" (M.B. Sobell and coll., 2000)

CAPRISO STUDY

Efficacy Variables

Cumulative abstinence duration

(CAD) in per cent

Clinical Global Impression

Medication compliance

CAPRISO STUDY

Cumulative abstinence days (%)

39

55

0

10

20

30

40

50

60

ITT

No Fu

Fu

p < 0.23

CAPRISO STUDY

Influence of baseline variables on CAD %

34

60

3541

0

20

40

60

Female Male

Fu

No Fu

5853 49

30

0

20

40

60

25-45 years 49-55 years

Fu

No Fu

%

Age

Gender

p = 0.21 (interaction test)

p = 0.33 (interaction test)

CAPRISO STUDY

Influence of baseline variables on CAD %%

Marital status

Education

5462

33

65

0

20

40

60

Nonmarried

Married

Fu

No Fu

4958 58

2833

67

0

20

40

60

None Secondary University

Fu

No Fu

%

p = 0.09 (interaction test)

p = 0.20 (interaction test)

CAPRISO STUDY

Influence of baseline variables on CAD %

3529

52

19

3734

37

53

72

45

0

20

40

60

Work Sick Disability Jobless Retired

Fu

No Fu

%

Employmentstatus

p = ns (interaction test)

CAPRISO STUDY

30

525655

0

20

40

60

FH + FH -

Fu

No Fu

%

Family history

p = 0.14 (interaction test)

51

65

4135

0

20

40

60

No SHG SHG

Fu

No Fu

Influence of baseline variables on CAD % Cont’d

p = 0.008 (interaction test)

Attendance to Self Help Group

CAPRISO STUDY

Structural modelling representation of regression analysis on CAD

Education

Marital status

F.U.

Female

SHG +

CAD

0.12

0.19

0.29

-0.24

-0.22

Regression analysis: R2 = .49

CAPRISO STUDY

30

40

50

60

70

80

90

100

V1 V2 V3 V4 V5 V6 V7 V8

No Fu

Fu

Medication Compliance

*: P<0.01

*

%

visit

CAPRISO STUDY

Rate of Complete Abstinence throughout a 6 month Period Evaluation after Detoxification

CAPRISO STUDY

RandomizedPlacebo-controlled

Study *

RandomizedPsycho-social follow-up

Study **

N = 104 N = 100

* Acamprosate in the treatment of alcohol dependence: a 6 months post-detoxification study - I. Pelc and coll, 1992

* * Capriso Study I. Pelc and coll, 2001

Placebo Acamprosate

4% 24%

Acamprosate

No Fu Fu

14% 32%