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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

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drinking habits self rating scale 1
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

drinking habits self rating scale 2
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 = seldom

2 = sometimes 3 = frequently

according to the global situation during the last 6 months

drinking habits self rating scale 3
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 = seldom

2 = sometimes 3 = frequently

according to the global situation during the last 6 months

modes of drinking alcoholism
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 time

and interrater reliability:

0 = never 2 = sometimes

1 = seldom 3 = frequently

slide5

ANGER 70 %

This person feels anger

1 2 3 4 5 6 7

Not at all

Very intensively

slide6

INTENSITY SCORES AS FUNCTION OF GROUP AND FACIAL EXPRESSION

I

n

t

e

n

s

i

t

y

s

c

o

r

e

s

Emotional Facial Expressions

Note. * p<.05; ** p<.01

Kornreich et al. (2001) Journal of Studies on Alcohol

slide7

COMPARISONS BETWEEN PERFORMANCES ON THE SERIAL AND THE ALPHABETICAL RECALL SCORES ON THE ALPHA-SPAN TEST

S

c

o

r

e

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)

slide8

AVERAGE NUMBER OF ERRORS MADE BY ALCOHOLICS AND CONTROLS

ON THE HAYLING TEST

P

o

i

n

t

s

o

f

p

e

n

a

l

t

y

Note. *** p<.001

relationship between positive and negative reinforcement

drug

RELATIONSHIP BETWEEN POSITIVE AND NEGATIVE REINFORCEMENT

drug

POSITIVE REINFORCEMENT

chemical drug reward

Glu, GABA, DA/endorphins

adapt

CHRONIC DRUG TOLERANCE

neurochemical adaptation

Glu RS, GABAA Rs, ? DA/Es

adapt

drug

drug

adapt

adapt

NEGATIVE REINFORCEMENT

exposure of neuronal adaptation

early minor signs of withdrawal

adaptation

WITHDRAWAL SIGNS

until adaptation is removed

DETOXIFICATION IS RELATIVELY EASY

MAJOR THERAPEUTIC PROBLEMS BEGIN HERE

conditioning of reinforcements craving
CONDITIONING OF REINFORCEMENTS = CRAVING?

Repeated pairing

"conditions"

associated

stimulus ("cue")

D

D

D

+ CUE

+ CUE

+ CUE

POSITIVE ASPECTS OF CRAVING

Conditioned stimulus (cue) elicits anticipation of drug reward

e.g. relaxation, euphoria, excitement

CUE

A

A

Cue becomes

conditioned

stimulus for

adaptation

D

D

A

D

+ CUE

+ CUE

+ CUE

A

NEGATIVE ASPECTS OF CRAVING

Conditioned stimulus (cue) elicits "pseudo-withdrawal"

e.g. anxiety, dysphoria, depression, tremor, etc.

CUE

the mechanisms of alcohol dependence
THE MECHANISMS OF ALCOHOL DEPENDENCE

Adaptation to alcohol as the basis for the Withdrawal Syndrome

Excitation

Littleton JM.

Addiction, 1995

CNS ACTIVITY

Withdrawal

syndrome

Acute effect

Development of tolerance

Inhibition

Withdrawal

Alcohol administration

Exposure of adaptation

causes hyperexcitation

Immediate CNS depressant effects of ethanol become limited by neurochemical adaptation

campral a novel action in alcohol dependence
Campral®: A NOVEL ACTION IN ALCOHOL DEPENDENCE

NORMAL

CHRONIC ALCOHOLISM

BRAIN

BAR

Alc

Exc

+

+

BALANCE

Exc

Inh

Inh

Exc

WITHDRAWAL

CRAVING

HYPER

EXCITATION

BAR Alc

Exc

BRAIN

Inh

Exc

BRAIN

Inh

+

(learned

association)

+

Exc

Exc

BALANCE

BRAIN

Campral® + CRAVING

(learned association)

Inh

Exc

effect of campral on disrupted neurotransmission

Campral®

EFFECT OF Campral® ON DISRUPTED NEUROTRANSMISSION

GABA

GABA

GABA +

Acute

alcohol

intake

Chronic

exposure

to alcohol

Adaptation

EAA -

EAA*

*Excitatory Amino Acids

Glutamate in particular

EAA

meta analysis method of hedges olkin 1985
META-ANALYSIS Method of Hedges & Olkin, 1985
  • Included 15 randomized placebo-controlled, double-blind studies
    • performed in 11 European countries
    • involved over 4,400 alcohol-dependent outpatients
  • Confirmed the significant effect of acamprosate versus placebo on abstinence parameters
  • Supports the generalizability of acamprosate data
acamprosate european double blind placebo controlled trials rate of total abstinence
ACAMPROSATE EUROPEAN DOUBLE-BLIND, PLACEBO-CONTROLLED TRIALSRate of Total Abstinence (%)

Overall Mean %:

Acamprosate = 35.7%

Placebo = 21.9%

D = 13.8%

results abstainers in patients on treatment 5 trials treatment duration 12 months
RESULTS: % ABSTAINERS IN PATIENTS ON TREATMENT 5 TRIALS (TREATMENT DURATION: 12 MONTHS)

%

*: p<0,001

*

*

*

*

*

Days

slide20

ABSTINENCE RATES FOR PATIENTS WHO

REMAINED IN THE TRIALS

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

%

*: p<0,001

*

*

*

*

*

Days

N = 3,338

N = 958

N = 2,876

N = 866

N = 1,679

N= 2,262

slide21

FOLLOW-UP PERIOD

(Sass et al.)

Continuous abstinence: time to first drink

100

90

80

70

60

Acamprosate

% Patients

50

Never had a drink

40

30

Placebo

20

10

0

0

120

180

240

300

360

420

480

540

600

660

720

60

Treatment Period

Follow-up Period

slide22
EFFECT OF CAMPRAL ON ABSTINENCE RATE, CUMULATIVE ABSTINENCE DURATION, COMPLIANCE TO TREATMENT AND CLINICAL GLOBAL IMPRESSION

Pelc I

BELGIUM

Results after 180 treatment days

* p<0.05

** p<0.005

**

*

*

% Patients

*

Abstinence rate

CAD

Compliance

CGI

Days

new european alcoholism treatment neat acamprosate program
NEW EUROPEAN ALCOHOLISM TREATMENT (NEAT) ACAMPROSATE PROGRAM
  • Open label, multicenter, multinational (5)
  • 1 281 alcohol-dependent patients
  • 6-month study duration
  • Concurrent group, individual, relapse prevention or brief intervention therapy
  • Comparisons of acamprosate efficacy across therapy conditions found
    • significant improvement in all groups in maintaining abstinence and reducing relapse duration
    • no difference between behavioral therapy groups
slide24

THERE IS NO DIFFERENCE IN CAD BETWEEN DIFFERENT TYPES

OF PSYCHOTHERAPY IN PATIENTS ON Campral®

Cumulative Abstinence Duration in days

by intervention type (per protocol)

conclusions 1
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

slide26

CONCLUSIONS (2)

Acamprosate Treatment Outcomes

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

Acamprosate increases QoL in enhancing abstinence.

Abstinence

Acamprosate

QOL

further questions
FURTHER QUESTIONS

1. The Role of the Environment

2. The Role of Cognitive Functioning

3. The Time Factor

slide28

CAPRISO STUDY

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 coll University Hospital Brugmann

Université Libre de Bruxelles BELGIUM

slide29

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
slide30

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)
slide31

CAPRISO STUDY

Efficacy Variables

  • Cumulative abstinence duration (CAD) in per cent
  • Clinical Global Impression
  • Medication compliance
influence of baseline variables on cad

CAPRISO STUDY

Influence of baseline variables on CAD %

%

Age

p = 0.33 (interaction test)

Gender

p = 0.21 (interaction test)

influence of baseline variables on cad34

CAPRISO STUDY

Influence of baseline variables on CAD %

%

Marital status

p = 0.20 (interaction test)

%

Education

p = 0.09 (interaction test)

influence of baseline variables on cad35

CAPRISO STUDY

Influence of baseline variables on CAD %

%

Family history

p = 0.14 (interaction test)

%

Employment

status

p = ns (interaction test)

slide36

CAPRISO STUDY

Influence of baseline variables on CAD % Cont’d

Attendance to Self Help Group

p = 0.008 (interaction test)

structural modelling representation of regression analysis on cad

CAPRISO STUDY

Structural modelling representation of regression analysis on CAD

Education

0.12

Marital status

0.19

CAD

0.29

F.U.

-0.24

Female

-0.22

SHG +

Regression analysis: R2 = .49

slide38

CAPRISO STUDY

Medication Compliance

%

*

visit

*: P<0.01

slide39

CAPRISO STUDY

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

Randomized

Psycho-social follow-up

Study **

Randomized

Placebo-controlled

Study *

N = 104

N = 100

Acamprosate

No Fu Fu

14% 32%

Placebo Acamprosate

4% 24%

* 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

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