Meta-Analyse zur Wirksamkeit von Acamprosat und Naltrexon in der Entwöhnungsbehandlung alkoholabhängiger Patienten

Ziel der Meta-Analyse ist eine aktualisierte Bewertung klinischer Studien zu Acamprosat und Naltrexon. Durch Einbeziehung unpublizierter Einzelbefunde konnte eine Kontrolle von Bias-Effekten erfolgen und die Wirkprofile beider Substanzen vervollständigt werden. Beide Substanzen erweisen sich in der Gesamtgruppe aller alkoholabhängigen Patienten als wirksam. Zur Aufrechterhaltung der Abstinenz ist Acamprosat das Mittel der Wahl. In der Subgruppe nicht-abstinenter Patienten erweist sich dagegen ausschließlich Naltrexon als geeignet, einen exzessiven Alkoholkonsum nach Abstinenzverstoß vorzubeugen

Pharmakotherapie der Alkoholentwöhnung: Update und neue Entwicklungen

So far few medications are approved for prophylactic treatment of alcohol dependence relapse. Apart from disulfiram, which is no longer marketed in Germany, the opioid antagonists naltrexone, nalmefene and the putative glutamate antagonist acamprosate are approved. In some other countries, baclofen and gamma-hydroxybutyrate (GHB) are licensed. Possible other drugs of interest for prophylaxis of alcohol dependence relapse are vareniclin, gabapentin, and topiramate, but so far none of them have received approval. In the light of the currently running revision of the German guidelines for the diagnosis and treatment of alcohol related disorders, an update on the pharmacotherapy of alcohol dependence is presented

Therapeutic success in relapse prevention in alcohol use disorder : the role of treatment motivation and drinking-related treatment goals

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Addictive Diseases on 5. Nov 2020, available online: http://www.tandfonline.com/10.1080/10550887.2020.1820810Background Changing addictive behavior is a complex process with high demands on motivation. The Transtheoretical Model of Behavior Change provides a theoretical framework for explaining and predicting behavioral change, although its predictive value for addiction is somewhat inconsistent. Objective The aim of the present study is to extend the Transtheoretical Model of Behavior Change by investigating not only treatment motivation but also the predictive value of the type of drinking-related treatment goal. Additional predictors, such as substance-related and sociodemographic variables, are also included in analyses seeking to predict return to drinking during relapse prevention treatment for alcohol use disorder. Methods In this observational study, 99 inpatients from a treatment center for alcohol use disorder were recruited. Treatment motivation was assessed in accordance with the Transtheoretical Model of Behavior Change, drinking-related treatment goal through a self-report questionnaire, and substance-related and sociodemographic variables via the clinic information system. Associations between the potential predictors and covariates were explored using stepwise logistic regression. Results During treatment, 42.6% of participants had at least one relapse. Scoring higher on the action dimension at admission (OR = 0.81, p = .04) and being employed (OR = 0.37, p = .02) were significant predictors of abstinence during treatment. Conclusions This study confirms that treatment motivation contributes to the prediction of treatment outcome, even when controlling for other variables. In future research, the underlying mechanisms of treatment motivation should be further explored

Enhancing monitoring and transboundary collaboration for conserving migratory species under global change: The priority case of the red kite

Calls for urgent action to conserve biodiversity under global change are increasing, and conservation of migratory species in this context poses special challenges. In the last two decades the Convention on the Conservation of Migratory Species of Wild Animals (CMS) has provided a framework for several subsidiary instruments including action plans for migratory bird species, but the effectiveness and transferability of these plans remain unclear. Such laws and policies have been credited with positive outcomes for the conservation of migratory species, but the lack of international coordination and on-ground implementation pose major challenges. While research on migratory populations has received growing attention, considerably less emphasis has been given to integrating ecological information throughout the annual cycle for examining strategies to conserve migratory species at multiple scales in the face of global change. We fill this gap through a case study examining the ecological status and conservation of a migratory raptor and facultative scavenger, the red kite (Milvus milvus), whose current breeding range is limited to Europe and is associated with agricultural landscapes and restricted to the temperate zone. Based on our review, conservation actions have been successful at recovering red kite populations within certain regions. Populations however remain depleted along the southern-most edge of the geographic range where many migratory red kites from northern strongholds overwinter. This led us to a forward-looking and integrated strategy that emphasizes international coordination involving researchers and conservation practitioners to enhance the science-policy-action interface. We identify and explore key issues for conserving the red kite under global change, including enhancing conservation actions within and outside protected areas, recovering depleted populations, accounting for climate change, and transboundary coordination in adaptive conservation and management actions. The integrated conservation strategy is sufficiently general such that it can be adapted to inform conservation of other highly mobile species subject to global change.Financial and logistic support were provided by GREFA, IREC, UCLM (Universidad de Castilla-La Mancha), CSIC and MITECO.Peer reviewe

What is the relapse risk during treatment? : survivor analysis of single and multiple relapse events in inpatients with alcohol use disorder as part of an observational study

Introduction: During treatment for alcohol use disorder (AUD), about 40% of patients return to drinking. Whether the risk of relapse changes during treatment and how relapses may affect the risk of subsequent relapse are unclear, however. The current study, therefore, aims to identify when and with what probability relapses occur. Methods: One hundred and three inpatients at an AUD treatment center participated in this observational study. The study documented relapse to drinking using breath analyzers, urine tests, and self-reported incidents for 42 days after the start of treatment. Time to the first relapse event and to any subsequent relapse event served as the outcome measures. The study determined the proportion of patients who had not experienced a relapse event at any given point by Kaplan-Meier estimates and Cox proportional hazards models. The study team computed the instantaneous probability of experiencing an event at any given point using generalized estimating equation (GEE) models of the binomial family with log-link and exchangeable correlation structure to estimate unadjusted and adjusted hazards. Results: Whereas the hazards of experiencing a first relapse event declined steadily over the 42 days, the hazards of experiencing a subsequent relapse following an initial event remained stable. Both first-time and recurrent relapses were positively associated with the number of DSM-5 AUD criteria. Conclusion: Whereas the risk of relapse declines with each day of abstinence during treatment, it remains high after an individual relapse for the first time. This finding implies that therapy should focus on strengthening selfefficacy for low-risk groups and on relapse-prevention strategies for high-risk groups

Metabotropic glutamate receptor 5 binding in male patients with alcohol use disorder

Glutamate signaling plays a major role in addiction. Preclinical research strongly suggests an implication of G-protein-coupled metabotropic glutamate receptor subtype 5 (mGluR5) in nicotine addiction and alcohol use disorder. In humans, smoking is related to a global reduction in mGluR5 availability. In the present study, we investigated mGluR5 in vivo in patients with alcohol use disorder without the confounding effects of smoking. A total of 14 male subjects with alcohol use disorder and at least a 25-day abstinence and 14 matched male non-smoking healthy controls were included in the study. We employed positron emission tomography (PET) with the mGluR5-specific radiotracer [11C]ABP688, using a bolus/infusion protocol. We found increased mGluR5 DVR in several regions within the temporal lobe in patients, as compared to controls. The largest between-group difference was in the amygdala. There was a marked positive relation between mGluR5 DVR in the anterior cingulate and mGluR5 DVR in the orbitofrontal cortex in patients, but not in controls. In patients, lower temptation to drink was related to higher amygdala mGluR5 DVR. We did not find altered mGluR5 DVR in the basal ganglia of subjects recovering from alcohol use disorder. In conclusion, our study provides clinical evidence for altered mGluR5 signaling in the amygdala in alcohol use disorder. This alteration was associated with the temptation to drink. In addition, this study suggests abnormal mGluR5 signaling in a network underlying reward-related behavioral flexibility. These findings strengthen the case for pharmacological agents acting on mGluR5 as promising candidates for the treatment of alcohol use disorder

Telephone‐ and Text Message–Based Continuing Care After Residential Treatment for Alcohol Use Disorder: A Randomized Clinical Multicenter Study

Background Alcohol use disorder (AUD) is characterized by extremely high rates of postresidential treatment relapse, and as such, continuing care to prevent relapse has become an important element in AUD treatment. In this regard, research has yielded heterogeneous evidence on telephone‐based (TEL) and text message–based (TEX) continuing care. We aimed to compare the effectiveness of TEL and TEX continuing care provided in different frequencies by psychotherapists for patients from residential treatments in mitigating the occurrence of posttreatment relapse in patients who completed a 12‐week abstinence‐oriented residential treatment program for AUD. Methods A total of 240 patients from 2 residential treatment programs for AUD were included in the study. Patients were randomly assigned to high‐ (10 contacts) or low‐frequency (3 contacts) TEL, TEX (10 contacts) continuing care, or control group (1 contact) from discharge to 6‐month follow‐up. The TEL was intended to be supportive and consisted of several cognitive behavioral therapy components, whereas the TEX was based on behavioral self‐monitoring techniques and additional calls in case of relapse or as needed. Sociodemographic, clinical, and alcohol‐specific variables at residential treatment discharge and at 5‐month follow‐up were assessed through interviews and questionnaires. Results Compared with the control group, patients in the high‐frequency TEL were significantly more abstinent at 6‐month follow‐up and, in case of relapse, showed a tendency toward a longer time to first drink. Moreover, the high‐frequency TEL and TEX groups had significantly higher alcohol‐related self‐efficacy 6 months after residential treatment. Conclusion High‐frequency proactive telephone contact by psychotherapists known to the patient may help patients to surmount the vulnerable phase after residential treatment and, in case of relapse, might help patients stay connected to health services, which in turn prevents chronification and facilitates recovery from AUD

Eine einfach-verblindete, randomisiert-kontrollierte Studie zu Mental Contrasting with Implementation Intentions (MCII) zur Verbesserung der Rückfallprävention bei stationären Patienten mit Alkoholkonsumstörung

Symposium «Neue Wege zur Verringerung des Substanzkonsums - Können Interventionen zur Verringerung des Substanzkonsums durch grundlegende motivierende Interventionen, die auf automatische Prozesse abzielen, unterstützt werden?"Hintergrund und Fragestellung: Selbst wenn Leitlinien und Rückfallpräventionstechniken eingehalten werden, bleibt die Behandlung von Alkoholkonsumstörungen (engl. Alcohol Use Disorder, AUD) herausfordernd, da Rückfälle häufig vorkommen. Craving und eingeschränkte Selbstregulation scheinen in diesem Zusammenhang eine wichtige Rolle zu spielen. Mental Contrasting with Implementation Intentions (MCII) ist eine effiziente und wirksame Selbstregulationsstrategie aus der Motivationspsychologie, die es Menschen ermöglicht, Hindernisse zu überwinden und Ziele zu erreichen. Die vorliegende Studie zielt darauf ab, MCII als Selbstregulationsstrategie zur Verringerung von Craving und Alkoholkonsum während einer Rückfallpräventionsbehandlung für AUD einzusetzen. Methoden: An dieser einfach-verblindeten, randomisierten, kontrollierten Studie nahmen 122 stationäre Patient:innen aus einem Behandlungszentrum für AUD teil. Die Teilnehmenden wurden in eine Gruppe, die MCII erhielt, und eine Gruppe, die ein Modul aus dem Rückfallpräventionsmodell erhielt und als aktive Kontrollgruppe diente, aufgeteilt. Das Craving wurde anhand einer visuellen Analogskala bewertet, während die Rückkehr zum Trinken von der Versuchsleitung auf der Grundlage von Selbstberichten der Patient:innen erfasst wurde. Ergebnisse: Zu Beginn der Behandlung nahm das Craving in der MCII-Gruppe im Vergleich zur Kontrollgruppe signifikant stärker ab. Bei späteren Messungen war dieser Effekt nicht mehr signifikant. Auch bei der Anzahl der Trinkereignisse gab es im Verlauf der stationären Behandlung keine Unterschiede zwischen der MCII-Gruppe und der aktiven Kontrollgruppe. Diskussion und Schlussfolgerung: Die MCII-Gruppe zeigte zu Beginn der Behandlung ein verringertes Craving im Vergleich zur aktiven Kontrollgruppe. Im Laufe der Zeit, als der normative Kontext der Klinik stärker wurde, unterschied sich die MCII-Gruppe jedoch nicht mehr von der aktiven Kontrollgruppe, weder in Bezug auf das Craving noch auf die Anzahl der Trinkereignisse. Der anfängliche Unterschied im Craving zu Beginn der Behandlung scheint zu schwinden, wenn der normative Kontext der Klinik dominanter wird. In künftigen Untersuchungen sollte diese Annahme durch Einbeziehung einer ambulanten Kontrollgruppe überprüft werden

Different Goals, Different Needs: The Effects of Telephone- and Text Message-Based Continuing Care for Patients with Different Drinking Goals After Residential Treatment for Alcohol Use Disorder.

AIMS Drinking goal has emerged as a promising predictor variable for alcohol-related outcomes. Many patients with alcohol use disorder (AUD) choose another drinking goal than abstinence after residential AUD treatment program. We aimed to examine the effects of an abstinent drinking goal (ADG) and conditional abstinence drinking goal (CADG) 6 months after residential treatment on drinking outcomes in patients with severe AUD and investigate the effectiveness of telephone-based (TEL) or text message-based (TEX) continuing care according to the individual drinking goal. METHODS A total of 240 patients from two specialized residential treatment programs for AUD were included in the study. Patients were randomly assigned to high-frequency (nine contacts) or low-frequency (two contacts) TEL, TEX (nine contacts), or control group (no contact) from treatment discharge to the 6-month follow-up. RESULTS Patients with an ADG were significantly more often abstinent (58%) at the 6-month follow-up compared to patients with a CADG (32.1%), and in the case of relapse, showed a significantly longer time to the first drink. Patients with a CADG of the high-frequency TEL showed a tendency to be more abstinent at the 6-month follow-up and reported significantly higher alcohol-related self-efficacy compared to the CADG patients of the control group. CONCLUSIONS Patients with CADG are more vulnerable to relapse, and therefore may benefit more from high-frequency telephone contacts to deal with alcohol-related problems and reach their goal. In the case of relapse, the high-frequent contacts may help patients stay connected to health services, preventing chronification and facilitating recovery from AUD