Angelina Isabella Mellentin

The risk of offspring developing substance use disorders when exposed to one versus two parent(s) with alcohol use disorder: A nationwide, register-based cohort study

AIM Few population-based, family studies have examined associations between exposure to one vs. two parent(s) with alcohol use disorder (AUD) and the risk of offspring developing substance use disorder (SUD). Moreover, these studies have focused solely on the development of AUD, and not SUD, in offspring. The purpose of this study was to investigate whether exposure to one vs. two parent(s) with AUD increases the risk of offspring developing SUD. METHODS A population-based, cohort study was conducted in which offspring born in Denmark between 1983 and 1989 were followed through national registries until 2011. Register-based data were obtained from the: Psychiatric Central Research Register, National Patient Registry, Civil Registration System, Fertility Database, and Cause of Death Register. Adjusted hazard ratios were calculated using multivariate Cox-regression models. FINDINGS A total of 398,881 offspring were included in this study. Of these, 3.9% had at least one parent with AUD. Parental AUD was significantly associated with the development of SUD in offspring. Having one parent with AUD was linked to a 1.44-fold increased risk (95% CL, 1.29-1.61), while having two parents with AUD was linked to a 2.29-fold increased risk (95% CI, 1.64-3.20). No significant differences were found in relation to either parental or offspring gender. CONCLUSIONS Exposure to parental AUD is linked to an increased risk of offspring developing SUD. This risk is additive for offspring exposed to double parental AUD. The findings have important implications for clinical assessment and intervention strategies, as well as the management of offspring exposed to parental AUD.

Cue exposure therapy for the treatment of alcohol use disorders: A meta-analytic review

Cue Exposure Therapy (CET) is a behavioristic psychological approach to treating substance use disorders (SUD). Prior systematic reviews have found CET to be ineffective when targeting SUDs. The effect of this approach on alcohol use disorders (AUD) seems more promising at trial level but has yet to be systematically reviewed and quantitatively analyzed. Therefore, we aimed to examine the effectiveness of CET targeting AUD compared to active control conditions in a meta-analytic review. Following a systematic search of the literature, a total of seven controlled trials were identified. CET showed no to small additional effects on drinking intensity and drinking frequency, a small additional effect on total drinking score and a moderate additional effect on latency to relapse. Stratification and analysis of a-priori defined trial covariates revealed that CET may have an increased effect in the longer term, and that CET combined with urge-specific coping skills may be the better option for treating AUD than conventional CET. Also, CET may prove less effective when comparing it to cognitive behaviour therapy as opposed to other active control conditions. The overall quality of evidence was graded low due to high risk of bias, inconsistency, imprecision and suspected publication bias. Sounder methodological trials are needed to derive a firm conclusion about the effectiveness of CET for treating AUD.

A randomized controlled study of exposure therapy as aftercare for alcohol use disorder: study protocol

AbstractBackgroundIt is well documented that individuals with Alcohol Use Disorder (AUD) respond well during evidence-based psychological treatment, but also that a large proportion relapses when discharged from treatment and confronted with alcohol in real life. Cue Exposure Treatment (CET) focuses on exposing individuals to alcohol cues in order to reduce cravings as well as the likelihood of relapse.The aims of the study are: 1) to investigate whether CET aftercare delivered via a smartphone or in group sessions increases the effect of Cognitive Behavioural Treatment in groups of alcohol dependent individuals; 2) to investigate whether CET as a smartphone application is as or more effective than CET group therapy, and 3) to investigate whether CET as a smartphone application is more cost-effective than CET group aftercare and Aftercare as Usual.Design and methodsThe study will be implemented as an investigator-blinded randomized controlled trial. A total of 300 consecutively enrolled alcohol use disorder individuals recruited from an alcohol outpatient clinic will be randomized into one of the three following aftercare groups after concluding primary treatment: (1) CET as a smartphone application; (2) CET as group therapy, and (3) Aftercare as Usual. It is hypothesized that the two experimental groups will achieve better treatment outcomes compared to the control group (3).DiscussionIndividuals in the CET groups are given the opportunity to practise coping strategies during exposure to alcohol stimuli before being unavoidably confronted with alcohol and associated stimuli in real life. Thus, CET may help prevent patients from relapsing after concluding treatment, and in the long term. Moreover, the CET application has the potential to improve AUD treatment and continuing care by offering psychological treatment whenever and wherever the patient finds it convenient.Trial registrationClinicalTrials.gov ID: NCT02298751 Registration date: 6 November 2014

Conscious knowledge influences decision-making differently in substance abusers with and without co-morbid antisocial personality disorder

Decision-making impairment, as measured by the Iowa Gambling Task (IGT), is a consistent finding among individuals with substance use disorder (SUD). We studied how this impairment is influenced by co-morbid antisocial personality disorder (ASPD) and conscious knowledge of the task. Three groups were investigated: SUD individuals without co-morbid ASPD (n = 30), SUD individuals with co-morbid ASPD (n = 16), and healthy controls (n = 17). Both SUD and SUD+ASPD participants had poor overall IGT performance. A block-by-block analysis revealed that SUD participants exhibited slow but steady improvement across the IGT, whereas SUD+ASPD participants exhibited initial normal improvement, but dropped off during the last 40 trials. Conscious knowledge of the task was significantly correlated to performance for controls and SUD participants, but not for SUD+ASPD participants. Our findings suggest that decision-making proceeds differently in SUD and SUD+ASPD individuals due to differences in acquisition and application of conscious knowledge.

A Smarter Pathway for Delivering Cue Exposure Therapy? The Design and Development of a Smartphone App Targeting Alcohol Use Disorder

Background Although the number of alcohol-related treatments in app stores is proliferating, none of them are based on a psychological framework and supported by empirical evidence. Cue exposure treatment (CET) with urge-specific coping skills (USCS) is often used in Danish treatment settings. It is an evidence-based psychological approach that focuses on promoting “confrontation with alcohol cues” as a means of reducing urges and the likelihood of relapse. Objective The objective of this study was to describe the design and development of a CET-based smartphone app; an innovative delivery pathway for treating alcohol use disorder (AUD). Methods The treatment is based on Monty and coworkers’ manual for CET with USCS (2002). It was created by a multidisciplinary team of psychiatrists, psychologists, programmers, and graphic designers as well as patients with AUD. A database was developed for the purpose of registering and monitoring training activities. A final version of the CET app and database was developed after several user tests. Results The final version of the CET app includes an introduction, 4 sessions featuring USCS, 8 alcohol exposure videos promoting the use of one of the USCS, and a results component providing an overview of training activities and potential progress. Real-time urges are measured before, during, and after exposure to alcohol cues and are registered in the app together with other training activity variables. Data packages are continuously sent in encrypted form to an external database and will be merged with other data (in an internal database) in the future. Conclusions The CET smartphone app is currently being tested at a large-scale, randomized controlled trial with the aim of clarifying whether it can be classified as an evidence-based treatment solution. The app has the potential to augment the reach of psychological treatment for AUD.

Accessibility of medical and psychosocial services following disasters and other traumatic events: experiences of Deaf and hard-of-hearing individuals in Denmark

Abstract Purpose: This descriptive study sought to explore barriers faced by Deaf and hard-of-hearing (D/HH) individuals in Denmark when accessing medical and psychosocial services following large-scale disasters and individual traumatic experiences. Methods: Semi-structured interviews were conducted with nine D/HH individuals who had experienced at least one disaster or other traumatic event. Results: Difficulties were encountered during interactions with first response and healthcare services, which centered on: (1) lack of Deaf awareness among professionals, (2) problems accessing interpreter services, (3) professionals relying on hearing relatives to disseminate information, and (4) professionals who were unwilling to adjust their speech or try different forms of communication. Barriers reported in relation to accessing psychosocial services included: (1) lack of all-Deaf or hard-of-hearing support groups, and (2) limited availability of crisis psychologists who are trained to service the needs of the hearing impaired. Suggestions for improvements to service provision were provided, including a list of practical recommendations for professionals. Conclusions: This study has identified significant gaps in post-disaster service provision for D/HH individuals. Results can inform policy makers and other authorities in the position to enhance existing services and/or develop new services for this vulnerable target population. Implications for Rehabilitation Being Deaf or hard-of-hearing compromises a person’s ability to obtain and share vital information during times of disaster. Medical and psychosocial services are expected to play critical response roles in times of disaster, and, should be properly equipped to assist Deaf and hard-of-hearing (D/HH) individuals. In a relatively small sample, this study highlights barriers faced by D/HH individuals in Denmark when accessing first response, healthcare, and psychosocial services following large-scale disasters and individual traumatic events, all of which centered on communication problems and resulted in suboptimal care. Regarding rehabilitation after disasters, evidence-based information about how to service the heterogeneous communication needs of D/HH populations should be disseminated to professionals, and preferably incorporated into training programs.

Comorbid social phobia does not predict the outcome in alcohol use disorder outpatient treatment

BACKGROUND Social phobia (SP) is one of the most prevalent anxiety disorders among patients entering treatment for alcohol use disorders (AUD). However, few studies have examined the association between SP and alcohol-related treatment outcomes in naturalistic settings. AIMS The aims of this study were to estimate the prevalence of co-morbid SP and to investigate the impact of the co-morbidity on the treatment course, dropout rates and treatment outcomes in a large sample of AUD patients treated in an outpatient alcohol treatment clinic. METHODS The study was conducted as an observational cohort study. A consecutive sample of 3.197 treatment-seeking outpatients, with an AUD diagnosis according to the ICD-10 Diagnostic Criteria for Research, was assessed by means of the Addiction Severity Index at treatment start and at treatment conclusion. RESULTS Approximately 15% of the patients suffered from SP when entering treatment and patients with and without SP did not differ on the treatment course, compliance or dropout rates. SP did not predict any alcohol-related treatment outcomes either, where no association was found on change scores for abstinence, drinking days and days with excessive drinking relative to AUD patients without co-morbidity. CONCLUSION AUD patients with and without co-morbid SP were equally likely to achieve benefits when treated similarly with evidence-based pharmacological and psychosocial approaches in a naturalistic setting.

The effect of co-morbid depression and anxiety on the course and outcome of alcohol outpatient treatment: a naturalistic prospective cohort study

Abstract Background: Studies examining the effect of alcohol treatment among patients with alcohol use disorders (AUD) and co-morbid depression and/or anxiety are few and show inconsistent, but mainly negative drinking outcomes. Aims: To describe the prevalence of anxiety and depression among Danish patients seeking treatment for an AUD, and to investigate the influence of psychiatric co-morbidity on the course and effect of treatment. Method: A consecutive sample of 363 outpatients with an AUD diagnosis according to the ICD-10 Diagnostic Criteria for Research was assessed by the means of the Addiction Severity Index at treatment start and 276 (76%) followed up after 1 year. Results: 15.7% of the patients suffered from depression and 12.7% from anxiety at baseline. Both patients with or without co-morbidity had improved on drinking outcome measures at follow-up with medium to large effect sizes. No difference was found between patients with and without co-morbidity. Conclusion: In contrast to the majority of prior studies, this study provides evidence that depression and anxiety do not have an effect on alcohol treatment. However, because of the naturalistic setting, a number of limitations should be taken into consideration interpreting the results.