Evaluation of adding the community reinforcement approach to motivational enhancement therapy for adults aged 60 years and older with DSM-5 alcohol use disorder

a randomized controlled trial

Kjeld Andersen, Silke Behrendt, Randi Bilberg, Michael P Bogenschutz, Barbara Braun, Gerhard Bühringer, Claus Thorn Ekstrøm, Anna Mejldal, Anne Helby Petersen, Anette Søgaard Nielsen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

AIM: To examine whether adding the Community Reinforcement Approach for Seniors (CRA-S) to Motivational Enhancement Therapy (MET) increases the probability of treatment success in people aged ≥ 60 years with alcohol use disorder (AUD).

DESIGN: A single blind multi-centre multi-national randomized (1 : 1) controlled trial.

SETTING: Out-patient settings (municipal alcohol treatment clinics in Denmark, specialized addiction care facilities in Germany and a primary care clinic in the United States).

PARTICIPANTS: Between January 2014 and May 2016, 693 patients aged 60+ years and fulfilling DSM-5 criteria for AUD participated in comparing MET (n = 351) and MET + CRA-S (n = 342).

INTERVENTION AND COMPARATOR: MET (comparator) included four manualized sessions aimed at increasing motivation to change and establishing a change plan. CRA-S (intervention) consisted of up to eight further optional, manualized sessions aimed at helping patients to implement their change plan. CRA-S included a specially designed module on coping with age and age-related problems.

MEASUREMENTS: The primary outcome was either total alcohol abstinence or an expected blood alcohol concentration of ≤ 0.05% during the 30 days preceding the 26 weeks follow-up (defined as success) or blood alcohol concentration of > 0.05% during the follow-up period (defined as failure). This was assessed by self-report using the Form 90 instrument. The main analysis involved complete cases.

FINDINGS: The follow-up rate at 26 weeks was 76.2% (76.9% in the MET group and 76.0% in the MET + CRA-S group). The success rate in the MET group was 48.9% [95% confidence interval (CI) = 42.9-54.9%] versus 52.3% (95% CI = 46.2-58.3%) in the MET + CRA-S group. The odds of success in the two conditions did not differ (odds ratio = 1.22. 95% CI = 0.86-1.75, P = 0.26, Bayes factor = 0.10). Sensitivity analyses involving alternative approaches to missing values did not change the results.

CONCLUSIONS: In older adults with an alcohol use disorder diagnosis, adding the 'community reinforcement approach for seniors' intervention to brief out-patient motivational enhancement therapy treatment did not improve drinking outcome.

Original languageEnglish
JournalAddiction
ISSN0965-2140
DOIs
Publication statusE-pub ahead of print - 28. Aug 2019

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Randomized Controlled Trials
Alcohols
Confidence Intervals
Outpatients
Denmark
Self Report
Drinking
Germany
Primary Health Care
Odds Ratio

Keywords

  • Alcohol use disorder
  • brief treatment
  • community reinforcement approach
  • motivational enhancement therapy
  • older adults
  • randomized trial

Cite this

@article{c8a1749071d1482a9931122072c03cf7,
title = "Evaluation of adding the community reinforcement approach to motivational enhancement therapy for adults aged 60 years and older with DSM-5 alcohol use disorder: a randomized controlled trial",
abstract = "AIM: To examine whether adding the Community Reinforcement Approach for Seniors (CRA-S) to Motivational Enhancement Therapy (MET) increases the probability of treatment success in people aged ≥ 60 years with alcohol use disorder (AUD).DESIGN: A single blind multi-centre multi-national randomized (1 : 1) controlled trial.SETTING: Out-patient settings (municipal alcohol treatment clinics in Denmark, specialized addiction care facilities in Germany and a primary care clinic in the United States).PARTICIPANTS: Between January 2014 and May 2016, 693 patients aged 60+ years and fulfilling DSM-5 criteria for AUD participated in comparing MET (n = 351) and MET + CRA-S (n = 342).INTERVENTION AND COMPARATOR: MET (comparator) included four manualized sessions aimed at increasing motivation to change and establishing a change plan. CRA-S (intervention) consisted of up to eight further optional, manualized sessions aimed at helping patients to implement their change plan. CRA-S included a specially designed module on coping with age and age-related problems.MEASUREMENTS: The primary outcome was either total alcohol abstinence or an expected blood alcohol concentration of ≤ 0.05{\%} during the 30 days preceding the 26 weeks follow-up (defined as success) or blood alcohol concentration of > 0.05{\%} during the follow-up period (defined as failure). This was assessed by self-report using the Form 90 instrument. The main analysis involved complete cases.FINDINGS: The follow-up rate at 26 weeks was 76.2{\%} (76.9{\%} in the MET group and 76.0{\%} in the MET + CRA-S group). The success rate in the MET group was 48.9{\%} [95{\%} confidence interval (CI) = 42.9-54.9{\%}] versus 52.3{\%} (95{\%} CI = 46.2-58.3{\%}) in the MET + CRA-S group. The odds of success in the two conditions did not differ (odds ratio = 1.22. 95{\%} CI = 0.86-1.75, P = 0.26, Bayes factor = 0.10). Sensitivity analyses involving alternative approaches to missing values did not change the results.CONCLUSIONS: In older adults with an alcohol use disorder diagnosis, adding the 'community reinforcement approach for seniors' intervention to brief out-patient motivational enhancement therapy treatment did not improve drinking outcome.",
keywords = "Alcohol use disorder, brief treatment, community reinforcement approach, motivational enhancement therapy, older adults, randomized trial",
author = "Kjeld Andersen and Silke Behrendt and Randi Bilberg and Bogenschutz, {Michael P} and Barbara Braun and Gerhard B{\"u}hringer and Ekstr{\o}m, {Claus Thorn} and Anna Mejldal and Petersen, {Anne Helby} and Nielsen, {Anette S{\o}gaard}",
year = "2019",
month = "8",
day = "28",
doi = "10.1111/add.14795",
language = "English",
journal = "Addiction",
issn = "0965-2140",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Evaluation of adding the community reinforcement approach to motivational enhancement therapy for adults aged 60 years and older with DSM-5 alcohol use disorder

T2 - a randomized controlled trial

AU - Andersen, Kjeld

AU - Behrendt, Silke

AU - Bilberg, Randi

AU - Bogenschutz, Michael P

AU - Braun, Barbara

AU - Bühringer, Gerhard

AU - Ekstrøm, Claus Thorn

AU - Mejldal, Anna

AU - Petersen, Anne Helby

AU - Nielsen, Anette Søgaard

PY - 2019/8/28

Y1 - 2019/8/28

N2 - AIM: To examine whether adding the Community Reinforcement Approach for Seniors (CRA-S) to Motivational Enhancement Therapy (MET) increases the probability of treatment success in people aged ≥ 60 years with alcohol use disorder (AUD).DESIGN: A single blind multi-centre multi-national randomized (1 : 1) controlled trial.SETTING: Out-patient settings (municipal alcohol treatment clinics in Denmark, specialized addiction care facilities in Germany and a primary care clinic in the United States).PARTICIPANTS: Between January 2014 and May 2016, 693 patients aged 60+ years and fulfilling DSM-5 criteria for AUD participated in comparing MET (n = 351) and MET + CRA-S (n = 342).INTERVENTION AND COMPARATOR: MET (comparator) included four manualized sessions aimed at increasing motivation to change and establishing a change plan. CRA-S (intervention) consisted of up to eight further optional, manualized sessions aimed at helping patients to implement their change plan. CRA-S included a specially designed module on coping with age and age-related problems.MEASUREMENTS: The primary outcome was either total alcohol abstinence or an expected blood alcohol concentration of ≤ 0.05% during the 30 days preceding the 26 weeks follow-up (defined as success) or blood alcohol concentration of > 0.05% during the follow-up period (defined as failure). This was assessed by self-report using the Form 90 instrument. The main analysis involved complete cases.FINDINGS: The follow-up rate at 26 weeks was 76.2% (76.9% in the MET group and 76.0% in the MET + CRA-S group). The success rate in the MET group was 48.9% [95% confidence interval (CI) = 42.9-54.9%] versus 52.3% (95% CI = 46.2-58.3%) in the MET + CRA-S group. The odds of success in the two conditions did not differ (odds ratio = 1.22. 95% CI = 0.86-1.75, P = 0.26, Bayes factor = 0.10). Sensitivity analyses involving alternative approaches to missing values did not change the results.CONCLUSIONS: In older adults with an alcohol use disorder diagnosis, adding the 'community reinforcement approach for seniors' intervention to brief out-patient motivational enhancement therapy treatment did not improve drinking outcome.

AB - AIM: To examine whether adding the Community Reinforcement Approach for Seniors (CRA-S) to Motivational Enhancement Therapy (MET) increases the probability of treatment success in people aged ≥ 60 years with alcohol use disorder (AUD).DESIGN: A single blind multi-centre multi-national randomized (1 : 1) controlled trial.SETTING: Out-patient settings (municipal alcohol treatment clinics in Denmark, specialized addiction care facilities in Germany and a primary care clinic in the United States).PARTICIPANTS: Between January 2014 and May 2016, 693 patients aged 60+ years and fulfilling DSM-5 criteria for AUD participated in comparing MET (n = 351) and MET + CRA-S (n = 342).INTERVENTION AND COMPARATOR: MET (comparator) included four manualized sessions aimed at increasing motivation to change and establishing a change plan. CRA-S (intervention) consisted of up to eight further optional, manualized sessions aimed at helping patients to implement their change plan. CRA-S included a specially designed module on coping with age and age-related problems.MEASUREMENTS: The primary outcome was either total alcohol abstinence or an expected blood alcohol concentration of ≤ 0.05% during the 30 days preceding the 26 weeks follow-up (defined as success) or blood alcohol concentration of > 0.05% during the follow-up period (defined as failure). This was assessed by self-report using the Form 90 instrument. The main analysis involved complete cases.FINDINGS: The follow-up rate at 26 weeks was 76.2% (76.9% in the MET group and 76.0% in the MET + CRA-S group). The success rate in the MET group was 48.9% [95% confidence interval (CI) = 42.9-54.9%] versus 52.3% (95% CI = 46.2-58.3%) in the MET + CRA-S group. The odds of success in the two conditions did not differ (odds ratio = 1.22. 95% CI = 0.86-1.75, P = 0.26, Bayes factor = 0.10). Sensitivity analyses involving alternative approaches to missing values did not change the results.CONCLUSIONS: In older adults with an alcohol use disorder diagnosis, adding the 'community reinforcement approach for seniors' intervention to brief out-patient motivational enhancement therapy treatment did not improve drinking outcome.

KW - Alcohol use disorder

KW - brief treatment

KW - community reinforcement approach

KW - motivational enhancement therapy

KW - older adults

KW - randomized trial

U2 - 10.1111/add.14795

DO - 10.1111/add.14795

M3 - Journal article

JO - Addiction

JF - Addiction

SN - 0965-2140

ER -