TREATMENT OUTCOMES IN PATIENTS WITH ALCOHOL DEPENDENCE IN A REHABILITATION PROGRAMME

Transcription

1 TREATMENT OUTCOMES IN PATIENTS WITH ALCOHOL DEPENDENCE IN A REHABILITATION PROGRAMME Susanne Yvette Young PhD candidate, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University.

2 Background This data forms part of a lager ongoing study titled; Association Between Motor Timing and Treatment Outcomes in Patients with Alcohol- and/or Cocaine Addiction in a Rehabilitation Programme. This research is conducted in collaboration with the University of Amsterdam, the University of Stellenbosch and the University of Lille, France.

3 Background Affective outcomes Research shows that individuals diagnosed with Depression and Alcohol Use Dependence (AUD) have poorer drinking outcomes than individuals with AUD without Depression Higher Depression has shown to lead to earlier treatment attrition, greater craving and relapse Findings are mixed however, with some studies not finding any difference in treatment outcomes due to Depression This highlights the need for AUD research to use depression as a measure of treatment outcome Studies have also shown that individuals with high alcohol use self efficacy* are more likely to apply coping skills and less likely to relapse *the belief in his her ability to resist the urge to drink Bates et al., 2002; Bates, Buckman, & Nguyen, 2013; Tate et al., 2008

4 Background Cognitive Deficits Most severe levels of cognitive deficits have been found during acute abstinence however there is a lack of consesus with regards to which functions are most severly affected and the rate of cognitive recovery of cognitive functions Attention, impulsivity and working memory deficits are commonly found in substance use disorders and are predictors of poor treatment outcomes and relapse in alcohol dependence specifically In clinical treatments to date a strong focus is placed on the physical, social, psychological and occupational problems and little attention goes out to the possible neurocognitive deficits within these populations Research shows that people with AUD have neurocognitive limitations and that these limitations can hinder treatment outcomes. Aharonovich et al., 2006; Arce & Santisteban, 2006; Bates et al., 2013; Bates, Bowden, & Barry, 2002; Goldstein & Volkow, 2011; Stavro, Pelletier and Potvin,2012; Stevens et al., 2014; Sullivan, Rosenbloom, Lim, & Pfefferbaum, 2000; Turner, LaRowe, Horner, Herron, & Malcolm, 2009; Verdejo-García, Lawrence, & Clark, 2008; Wittmann & Paulus, 2008

5 Aims We aimed to explore neuropsychological deficits in a acute abstinent individuals diagnosed with AUD at treatment start compared to treatment completion Additionally we aimed to explore rates of depression and self rated self efficacy to abstain from alcohol use pre and post treatment

6 Hypotheses We hypothesised; That AUD individuals would perform less well pre treatment compared to post treatment, with regards to neuropsychological functioning (memory, impulsivity, cognitive flexibility). We expected that individuals with AUD would score lower on auditory (Letter Number Sequencing) and visual memory (CORSI); would have a lower cognitive flexibility (Trail Making Task), and have lower cognitive flexibility (Emotional Stroop Task) with regards to automatic (congruent condition) and emotional (alcohol condition) stimuli. Furthermore we expected that patients would react more impulsive (Stop Signal Task) and make more impulsive choices (Iowa Gambling Task) as compared to post-treatment. That AUD individuals would improve on an affective level at completion of treatment. We expected that patients would score similar on depression and anxiety (BECK), similar on the degree of emotional self-efficacy with regards to abstinence to alcohol use (Alcohol Abstinence Self-Efficacy Scale) post-treatment as compared to pre treatment.

7 Methods procedures As part of an ongoing doctoral research project (Susanne Young in progress) at Momentum Health SA/Rustenburg Addiction Care neurocognitive and affective outcomes of a group of AUD patients were assessed pre and post treatment. Twenty-four abstinent patients diagnosed with AUD were examined through the use of questionnaires and a neurocognitive task battery. The recruitment age of the group was years old The self-reported questionnaires examined; i) depression and ii) self-efficacy to abstain from alcohol use. Patients were tested at two points in time: (i) within 72 hours of the start of the intervention, (ii) after completion of the intervention at eight weeks (measure of treatment response). Only quantitative data was collected. All diagnostic tools and assessments were be administered in Dutch (all patients admitted to the clinic are Dutch nationals).

8 Methods Questionnaires Clinical and demographic questionnaires (part of clinical intake procedures) Edinburg Handedness Questionnaire, assesses handedness (Oldfield, 1970) MINI (Lecrubier et al., 1997). Diagnostic Interview for DSM MATE- 2.01, The Measurements in the Addictions for Triage and Evaluation.2.01 (MATE.2.01) (Schippers et al. 2010). AUDIT, Alcohol Use Identification Test (Wade, Varker, O'Donnell, & Forbes, 2011). DUDIT, The Drug Use Identification Tests, (Berman, Bergman, Palmstierna, & Schlyter, 2005). Beck Depression Inventory BDI, Beck Depression Inventory (Beck, Steer, & Carbin, 1988). SDS, Sheehan Disability Scale (Leon, Olfson, Portera, Farber, & Sheehan, 1997) SWS, withdrawal symptom checklist The alcohol abstinence self-efficacy scale (DiClemente et al 1994)

9 Methods Neuropsychological Tasks The Stroop Colour Word Task, The Stoop is a test of selective attention, processing and flexibility (Lezak, Howieson, & Loring, 2004). We used a modified STROOP including conditions with Alcohol related stimuli (Prof A Goudriaan, AMC, The Netherlands Stop signal response inhibition ( Logan, 1994; Logan & Cowan, 1984) AND cognitive control (Kalanthroff, Goldfarb & Henik, 2013). Corsi, (Kessels, van Zandvoort, Postma, Kappelle, & de Haan, 2000) (task to assess spatial memory: attention and immediate memory capacity of environmental and special information Trail Making Test (TMT), test of orientation and attention (Lezak et al., Letter- Number Shifting, The Letter- Number Sequencing Task (LNS) is the working memory measurement scale of the Wechsler Adult Intelligence Scale (WAIS III, Lezak et al., 2004) and specifically measures Attention, concentration, mental control. Iowa Gambling Task, assesses every day decision making capabilities and used as a clinical tool assessing risky decision making (Buelow & Suhr, 2009).

10 N=24 Gender Ethnicity Male Female Coloured Results Demographics Caucasian 20 Mean SD Age Education (verhage) Years of use Years suffering from SUD Days of use (30 days) Units (30 days) Audit Comobility (MINI)*

11 Results Neuropsychological tasks No improvements were found on visual working memory and motor impulsivity performances (nonsignificant) Improvements were found on Auditory working memory performance (Letter Number Sequencing task (F (1.23) = 10,837, p <.05); Impulsive choice (Iowa Gambling Task, F = (1.21) = , p <.05) Cognitive flexibility (Trail Making Test (F (1.18) = , p =.05 *). *T-test calculated based on Dutch norm group data

12 Results Significant improvement of STROOP over time (treatment outcome); The Alcohol group can suppressed the automatic response (RED) better in time The Alcohol group can supress an emotional reaction better in time (DRINKING) 1150 time*condition; LS Means Current effect: F(1, 19)=9.2303, p= Type III decomposition Vertical bars denote 0.95 confidence intervals 1000 time*condition; LS Means Current effect: F(1, 19)=7.9663, p= Type III decomposition Vertical bars denote 0.95 confidence intervals a 950 a 1000 b 900 b STROOP c c stroop 850 b b time CONDITION congruent CONDITION incongruent time condition alcohol condition neutral

13 Results Affective measures With regards to the affective measurements significant results were found on; Depression (Beck, F, (1.12) = , p <.05) Significant improvement of Depression Symptoms over time (treatment outcome); The overall depression scores went from moderate depression to mild mood disturbance Alcohol use Self-Efficacy (The Alcohol Abstinence Self-Efficacy Scale, F, (17 447, p <.05) Self efficacy to avoid Alcohol use is significantly improved

14 Conclusions This study shows that patients diagnosed with AUD admitted for an 8 week inpatient rehabilitation programme significantly improve on a neurocognitive and affective level, These results relate specifically to impulsive choice, cognitive flexibility and auditory working memory but also to symptoms of Depression and Alcohol Abstinence Self Efficacy. Results give an indication that intensive inpatient treatment may significantly improve neuropsychological, cognitive and affective deficits experienced by individuals suffering from AUD

15 Limitations of the research No other treatment centres or outcomes from other clinics to compare thus treatment effect cannot be assessed, only assumed. The inclusion and exclusion criteria of the ongoing study are very strict This may cause homogenic results The result may only be applicable to a certain subpopulation of the AUD- e.g. the only the people that need to be admitted for inpatient treatment This research was based on Dutch AUD patients admitted to a South African private clinic and thus results may not be applicable to the South African context

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17 Acknowledgements All patients that have participated in this research Momentum Mental Healthcare South Africa and Rustenburg Addiction Care for facilitating the research Ms Anouk Albien and ms Merel van Gelder for their research assistance on this project The research support received from the South African Research Chairs initiative of the Department of Science and Technology and the National Research Foundation of South Africa The research support received from the Nedgroup Trust Educational Bursary Programme-Hendrik Vrouwes Bursary Additional research support received from University of Amsterdam and the University of Lille, France. All data analysis has been conducted with the help of a statistician (Prof M. Kidd of Stellenbosch University).