Search

Aim: To test the feasibility of a participatory design intervention aimed at reducing the risk of cardio-vascular disease among patients suffering from alcohol use disorder (AUD) or severe mental illness (SMI). Methods: The intervention was developed by patients from the Community Mental Health Center and the Alcohol Treatment Facility in Odense, Denmark, and consisted of eight modules (health interviews, screening and treatment, introduction, diet/alcohol, physical activity, smoking, health app, and sleep problems). The intervention was tested using pre- and post-measurements of selected variables, patients' intervention attendance, and interviews and dialogue workshops at the end of the study. Results: A total of 21 out of 42 eligible patients from the Alcohol Treatment Facility and two out of 443 eligible patients from the Community Mental Health Center accepted participation in the study. The two patients from the Community Mental Health Center were not included in the analyses due to General Data Protection Regulation (GDPR). All patients accepted being screened for risk factors at inclusion, and the majority enrolled in at least one of the subsequent modules. The study indicated that the patients followed recommendations from their GPs. Conclusions: There is a great need for focus on cardio-vascular disease in patients with SMI and those with AUD. Results indicate that the intervention is feasible for patients with AUD, but due to inclusion of too few patients with SMI, nothing can be concluded for this patient group. Patients and staff in the Alcohol Treatment Facility agreed that the intervention has future perspectives. [ABSTRACT FROM AUTHOR]

Background: In addition to increasing the quality of life among concerned significant others (CSOs), Community Reinforcement and Family training (CRAFT) aim at helping CSOs motivate treatment-refusing identified patients (IPs) into treatment through a positive reinforcement process. The aim of the present study was to investigate if the following factors, measured at baseline, have an influence on IP future treatment engagement (1) Type of relation between CSO and the IP (2) The amount of time the CSO spend with the IP (3) if the IP knows that the CSOs seeks help, and (4) The CSO's own alcohol use. Methods: A secondary analysis from the Danish CRAFT study. CSOs completed a self-administered questionnaire at baseline, after three months, and six months. To investigate the relationship between the four variables and treatment engagement, logistic regression was used. Results: CSO's relation to the IP, the frequency of contact between the CSO and the IP, and the CSO's AUDIT score at the time of the baseline interview were not associated with the IP's treatment engagement. If CSO at baseline had informed the IP that the CSO participated in CRAFT, odds for IP treatment engagement were significantly higher (adjusted OR [(CI)] = 2.29 [1.13; 4.63] (p < 0.05), relative to if IP not being informed. Conclusions: CRAFT has a higher impact on the likelihood for treatment seeking, if the CSOs inform the IP about his or her own help seeking in order to change the situation. The underlying mechanism behind this is needs further investigations. [ABSTRACT FROM AUTHOR]

Community reinforcement and family training (CRAFT) was developed to help and support concerned significant others (CSO) of people with, for example, alcohol use disorder. The aim of this study was to investigate therapists' experiences of working with CRAFT and their experiences of the CSOs receiving CRAFT. The study has a qualitative design and is based on three focus group interviews with 17 therapists. Interviews were analysed using thematic analysis. The analysis revealed six themes and four subthemes: Concerned significant others—A special group; Help prior to CRAFT—Offering information and a shoulder; CRAFT as a new and specific method (The toolbox of CRAFT, Formats for delivering CRAFT, Introducing a diary as homework and Implementing self‐help material—Alone or in combination with sessions); Moving from a lack of structure to structure; Change in CSOs from the therapists' point of view; and Change in the therapist's role (Dilemmas—Personalising the intervention). The therapists were generally satisfied with the method and found it easy to adapt to. Moreover, working using a manual was more structured than they were used to and increased feelings of working professionally with the CSOs. Specifically, most therapists found the self‐help book useful and indispensable in their work with CRAFT, but also agreed that it could not be used as a stand‐alone intervention for most CSOs. The therapists' experiences are relevant for implementation of manualised, structured approaches and group‐based interventions more broadly. [ABSTRACT FROM AUTHOR]

Background: Community Reinforcement and Family Training (CRAFT) is an intervention designed to help the concerned significant others (CSOs) of people with alcohol problems who are reluctant to seek treatment. It aims to improve the well-being of CSOs and teach them how to change their behavior in order to positively influence the "identified patient" (IP) to seek treatment.Methods: The aim of the present pragmatic cluster-randomized trial was to compare the effectiveness of three formats for delivering CRAFT in real life settings: group sessions, individual sessions, and written material only (control group). Eighteen public treatment centers for alcohol use disorders were randomly assigned to deliver CRAFT in one of the three formats as part of their daily clinical routine. CSOs were recruited via pamphlets, general practitioners, and advertisements on social media. Trained clinicians delivered CRAFT in individual and group format, and self-administered CRAFT was limited to handing out a self-help book. The primary outcome was treatment engagement of the IP after three months.Results: A total of 249 CSOs were found to be eligible and randomly assigned to receive CRAFT delivered in group, individual, or self-administered format. The three-month follow-up rate was 60%. At three months follow-up, 29% (n = 32) of the CSOs who received group/individual CRAFT reported that their IP had engaged in treatment. The corresponding rate for the CSOs who received self-administered CRAFT was lower (15%; n = 5) but did not differ significantly from the other group of CSOs (Odds ratio (OR) = 2.27 (95% CI: 0.80, 6.41)).Conclusion: We hypothesized that CSOs receiving CRAFT in a group format would improve the most, but although our findings pointed in this direction, the differences were not statistically significant.Trial Registration: Clinical trials.gov ID: NCT03281057 . Registration date:13/09/2017. [ABSTRACT FROM AUTHOR]

Introduction: Heavy drinking causes serious harm, not only to the drinker but also to relationships and concerned significant others (CSOs). Community Reinforcement and Family Training (CRAFT) is an intervention developed to help the CSOs of substance users. The aim of this study was to investigate the drivers and aims underlying CSO participation in CRAFT, as well as their experience of the intervention itself and their module preferences. Method: This is a qualitative study based on data from semi-structured interviews with 11 female help-seeking CSOs of individuals with alcohol problems. The participants were recruited from an RCT study of a variety of CRAFT delivery formats (group sessions + written material, individual sessions + written material or self-delivered CRAFT with written material only). The interviews were audio-recorded, transcribed, and analyzed by Interpretative Phenomenological Analysis. Results: CSOs reported CRAFT helpful when both delivered by means of individual sessions or group sessions. The "Communication Element" in CRAFT, the module focusing on positive reinforcement and acquiring a clearer understanding of AUD, appeared to be particularly helpful elements of CRAFT. Furthermore, being met with acceptance and non-judgmental attitudes seemed to count highly for the CSOs. The written material a helpful supplement to the face-to-face interventions. The written material a helpful supplement to the face-to-face interventions. Conclusion: CSOs who participated in the CRAFT intervention felt helped by its components, irrespective of delivery format. [ABSTRACT FROM AUTHOR]

Aims: To examine whether physical activity as an adjunct to outpatient alcohol treatment has an effect on alcohol consumption following participation in an exercise intervention of six months’ duration, and at 12 months after treatment initiation. Methods: The study is a randomized controlled study with three arms: Patients allocated to (A) treatment as usual, (B) treatment as usual and supervised group exercise, (C) treatment as usual and individual physical exercise. The primary outcome measure was excessive drinking six months after treatment start and completion of the intervention. A logistic regression model was used to evaluate the odds of excessive drinking among the three groups, based on intention-to-treat. Changes in level of physical activity in all three groups were tested by using a generalized linear mixed model. A multiple linear model was used to test if there was an association between amount of performed physical activity and alcohol consumption. Results: A total of 175 patients (68.6% male) participated. Response rates were 77.7% at six months and 57.1% at 12 months follow-up. OR 0.99 [95% CI: 0.46; 2.14], p = 0.976 for excessive drinking in the group exercise condition, and 1.02 [95% CI: 0.47; 2.18], p = 0.968 in the individual exercise condition, which, when compared to the control group as reference, did not differ statistically significantly. Participants with moderate level physical activity had lower odds for excessive drinking OR = 0.12 [0.05; 0.31], p<0.001 than participants with low level physical activity. Amount of alcohol consumption in the intervention groups decreased by 4% [95% CI: 0.03; 6.8], p = 0.015 for each increased exercising day. Conclusions: No direct effect of physical exercise on drinking outcome was found. Moderate level physical activity was protective against excessive drinking following treatment. A dose-response effect of exercise on drinking outcome supports the need for implementing physically active lifestyles for patients in treatment for alcohol use disorder. [ABSTRACT FROM AUTHOR]

Background: A large proportion of the Danish population consumes more than the officially recommended weekly amount of alcohol. Untreated alcohol use disorders lead to frequent contacts with the health care system and can be associated with considerable human and societal costs. However, only a small share of those with alcohol use disorders receives treatment. A referral model to ensure treatment for alcohol dependent patients after discharge is needed. This study evaluates the i) cost-effectiveness ii) efficacy and iii) overall impact on societal costs of the proposed referral model - The Relay Model.Method/design: The study is a single-blind pragmatic randomized controlled trial including patients admitted to the hospital. The study group (n = 500) will receive an intervention, and the control group (n = 500) will be referred to treatment by usual procedures. All patients complete a lifestyle questionnaire with the Alcohol Use Disorders Identification Test embedded as a case identification strategy. The primary outcome of the study will be health care expenditures 12 months after discharge. The secondary outcome will be the percentage of the target group, who 30 days after discharge, reports at the alcohol treatment clinics. In order to analyse both outcomes, difference-in-difference models will be used.Discussion: We expect to establish evidence as to whether The Relay Model is either cost-neutral or cost-effective, compared to referral by usual procedures.Trial Registration: https://register.clinicaltrials.gov/by identifier: RESCueH_Relay NCT02188043 Project Relay Model for Recruiting Alcohol Dependent Patients in General Hospitals (TRN Registration: 07/09/2014). [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that patients' anxiety and dissatisfaction are predictors for increased postoperative pain and reduced efficacy of pain treatment. However, it remains to be shown whether patient anxiety and concern are predictors for the perceived quality of treatment and patient reported outcome (PRO). The aim of this study is to investigate whether there is a correlation between preoperative anxiety and concern, and the perceived quality of postoperative treatment and outcome. The hypothesis is that anxious and concerned patients are less satisfied with treatment and have a poorer outcome. Methods/design: This study is designed as a prospective follow-up study and has the aim of investigating the correlation between patient anxiety and concern, patients´ perceived quality of treatment and outcome. This correlation will be detected using five questionnaires: CMD-SQ (Common Mental Disorders Screening Questionnaire), EuroQol 5 Dimensions (EQ-5D), Short form 12 (SF-12), "What is your evaluation of the patient progress in the Department of Orthopaedic Surgery?" (HVOK), Questionnaire for patients who have had hip surgery (RCS) and Oxford Hip Score (OHS) or Oxford Shoulder Score (OSS). The patients will complete the above mentioned questionnaires preoperatively in the outpatient department, and postoperatively just before discharge from the inpatient department, and 12 and 52 weeks after the operation. The study includes a reliability test of CMD-SQ regarding this specific population and tested by means of a Kappa. A total of 500 hip- and shoulder-patients will be included from October 2010 till October 2011. Discussion: If a correlation between patient anxiety and concern, patients´ perceived quality of treatment and patient reported outcome is found, it will be recommended to screen all hip- and shoulder-patients for anxiety and concern preoperatively. Besides, it would be relevant to carry out investigations of possible interventions towards anxious and concerned patients. Trial registration: Current Controlled Trials: NCT01205295 [ABSTRACT FROM AUTHOR]

Background: A physically active lifestyle contributes to the prevention of lifestyle diseases, promotion of physical health, and reduction of pain, among other benefits. Being physically active also promotes mental health for many individuals, in the form of improved mood, increased self-efficacy and reduced risk of depression. Alcohol-dependent individuals may experience a better quality of life when supplementing their treatment with physical exercise. This study aimed to evaluate the effect of exercise on Quality of Life among patients with alcohol use disorder in a large randomized controlled trial.Methods: The study had three arms: Patients were allocated to (A) treatment as usual, (B) treatment as usual and supervised group exercise two days a week of one hour each, (C) treatment as usual and individual physical exercise minimum two days a week. Duration of the intervention was six months. Data on values of Quality of Life were collected at baseline (before treatment start and at time of enrollment in the study), and at follow-up (at six months after enrollment in the study) using the EQ-5D questionnaire and the EQ-VAS. The sample consisted of 117 consecutive patients, and the follow-up rate was 66.6%. Intention-to-treat analyses were conducted to evaluate the effect of exercise on quality of life.Results: Although not statistically significant, a substantial portion of the participants in the individual exercise condition reported that they had no pain or discomfort (one of the five quality of life dimensions measured by EQ-5D questionnaire) compared to the controls at follow-up. No difference was found between the groups regarding the EQ-VAS.Conclusion: The exercise intervention had no effect on quality of life for patients with alcohol use disorder, nor was quality of life improved across the total sample. More research in how to improve quality of life for patients with alcohol use disorder is needed.Trial Registration: ISRCTN74889852 (retrospectively registered, date: 16/05/2013). [ABSTRACT FROM AUTHOR]

Background: A major challenge to psychological treatment for alcohol use disorder (AUD) is patient non-compliance. A promising new treatment approach that is hypothesized to increase patient compliance is blended treatment, consisting of face-to-face contact with a therapist combined with modules delivered over the internet within the same protocol. While this treatment concept has been developed and proven effective for a variety of mental disorders, it has not yet been examined for AUD. Aims: The study described in this protocol aims to examine and evaluate patient compliance with blended AUD treatment as well as the clinical and cost effectiveness of such treatment compared to face-to-face treatment only. Methods: The study design is a pragmatic, stepped-wedge cluster randomized controlled trial. The included outpatient institutions (planned number of patients: n = 1800) will be randomized in clusters to implement either blended AUD treatment or face-to-face treatment only, i.e. treatment as usual (TAU). Both treatment approaches consist of motivational interviewing and cognitive behavioral therapy. Data on sociodemographics, treatment (e.g. intensity, duration), type of treatment conclusion (compliance vs. dropout), alcohol consumption, addiction severity, consequences of drinking, and quality of life, will be collected at treatment entry, at treatment conclusion, and 6 months after treatment conclusion. The primary outcome is compliance at treatment conclusion, and the secondary outcomes include alcohol consumption and quality of life at six-months follow-up. Data will be analyzed with an Intention-to-treat approach by means of generalized linear mixed models with a random effect for cluster and fixed effect for each step. Also, analyses evaluating cost-effectiveness will be conducted. Discussion: Blended treatment may increase treatment compliance and thus improve treatment outcomes due to increased flexibility of the treatment course. Since this study is conducted within an implementation framework it can easily be scaled up, and when successful, blended treatment has the potential to become an alternative offer in many outpatient clinics nationwide and internationally. Trial registration: Clinicaltrials.gov.: NCT04535258, retrospectively registered 01.09.20. [ABSTRACT FROM AUTHOR]

Objective: Understanding the variation of alcohol use disorder (AUD) among a clinical sample of patients aged 60 and older, by identifying latent classes of AUD and exploring risk factors and outcomes of treatment associated with the class. Method: We used the Danish subsample (n = 341) from the Elderly Study. Latent class analysis was used to identify classes based on the 11 symptoms of DSM-5 AUD. We analyzed the associations between class membership and sociodemographic variables, alcohol consumption, and drinking-related outcome of treatment. Results: Three latent classes were identified. Individuals in the low-symptomatic class (34.85%) displayed low endorsement of DSM-5 criteria "Withdrawal", "Time Spent", "Less activities" compared to the other classes, and had fewest drinks per drinking day. Individuals in the moderate-symptomatic class (32.69%) were most likely to be intoxicated in hazardous situations, and those in the high-symptomatic class (32.47%) displayed, with a few exceptions, the highest probabilities of all DSM-5 criteria. Female gender, living alone and prior AUD treatment was associated with increased risk of being in the high-symptomatic class. No difference between classes was found with respect to years with AUD and frequency of drinking days, and latent class membership had no effect on drinking outcome after treatment, when controlling for baseline. Conclusions: Three classes of DSM-5 AUD among older adults in treatment emerged, displaying a low-moderate-high distribution, advocating for a unidimensional construct of DSM-5 AUD. Although different with respect to baseline risk factors, no strong connection between DSM-5 latent class and alcohol consumption after AUD treatment was found. Among 341 older alcohol use disorder (AUD) outpatients, three latent classes of DSM-5 AUD emerged. The classes of DSM-5 AUD displayed a low-moderate-high endorsement of DSM-5 AUD characteristics. The three classes had similar alcohol-related treatment outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the psychometric properties of the frequently used Alcohol Dependence Scale (ADS) in older adults and the associations between ADS scores and alcohol use and DSM‐5 AUD symptom counts. Methods: Using baseline data from an international multicenter RCT on outpatient AUD treatment for adults aged 60+ with DSM‐5 alcohol use disorder (AUD; n = 529), we computed Cronbach's alpha (α) and applied confirmatory (CFA) and exploratory factor analysis (EFA) to determine the underlying factor structure. A structural equation model (SEM) explored the interrelationship of latent ADS factors with alcohol use and number of DSM‐5 criteria endorsed. Results: Internal consistency of the ADS (α = 0.81) was good. EFA revealed a three‐factor structure. Factor 1 ("Severe withdrawal symptoms") consisted of severe psychoperceptual and psychophysical consequences of excessive drinking, Factor 2 ("Loss of control") consisted of acute physical reactions of intoxication, and Factor 3 ("Obsessive–compulsive drinking") described habitual drinking. The SEM suggested that only Factor 3 had large effects on DSM‐5 symptom score and drinking behavior. Conclusion: Lowering the ADS threshold or focusing on ADS items from Factor 3 may be more suitable measures of severity of alcohol dependence in treatment‐seeking older adults as ADS scores are low and not closely related to DSM‐5 AUD. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article presents the discussion on correction notice "Gender Differences in Alcohol Treatment" including threat to health worldwide and leads to substantial expenses for society.

Applying philosophical theories with a view to increasing understanding gives us a platform to discuss issues such as moral responsibility in the context of an alcohol use disorder (AUD). The present study investigates moral responsibility and control in people suffering from AUD using the theory of reasons-responsiveness (TRR). Three participants were included in this study—one woman and two men, all older than age 55. They were interviewed for approximately 60 minutes, using a semistructured format. The transcripts were analyzed utilizing a slightly modified version of interpretative phenomenological analysis. The findings illustrate a set of different factors that can influence the moral responsibility and control exercised by people suffering from AUD. The authors found that notions such as habit and situational awareness were important in capturing the participants' experiences of AUD. The participants' statements were used as examples in discussing moral responsibility in relation to TRR. Many factors may influence the moral responsibility of a person suffering from AUD, and even though choice and self-direction can be impaired by AUD, moral responsibility may still manifest itself in different ways. [ABSTRACT FROM AUTHOR]

Control and moral responsibility are important considerations in our understanding of alcohol use disorders (AUDs). The ability of persons experiencing AUD, especially the degree of freedom they enjoy in the presence of craving, is pivotal. The theory of reasons-responsiveness (TRR) offer a theoretical framework to explore the degree of freedom that persons experiencing SUDs have in their ability to drink or not to drink. They propose that in the absence of ignorance and coercion degrees of freedom of choice exist together with moral responsibility. [ABSTRACT FROM AUTHOR]

Background: The number of older adults with alcohol use disorder (AUD) is expected to rise. Adapted treatments for this group are lacking and information on AUD features in treatment seeking older adults is scarce. The international multicenter randomized-controlled clinical trial "ELDERLY-Study" with few exclusion criteria was conducted to investigate two outpatient AUD-treatments for adults aged 60+ with DSM-5 AUD. Aims: To add to 1) basic methodological information on the ELDERLY-Study by providing information on AUD features in ELDERLY-participants taking into account country and gender, and 2) knowledge on AUD features in older adults seeking outpatient treatment. Methods: baseline data from the German and Danish ELDERLY-sites (n=544) were used. AUD diagnoses were obtained with the Mini International Neuropsychiatric Interview, alcohol use information with Form 90. Results: Lost control, desired control, mental/physical problem, and craving were the most prevalent (> 70 %) AUD-symptoms. 54.9 % reported severe DSM-5 AUD (moderate: 28.2 %, mild: 16.9 %). Mean daily alcohol use was 6.3 drinks at 12 grams ethanol each. 93.9 % reported binging. More intense alcohol use was associated with greater AUD-severity and male gender. Country effects showed for alcohol use and AUD-severity. Conclusion: European ELDERLY-participants presented typical dependence symptoms, a wide range of severity, and intense alcohol use. This may underline the clinical significance of AUD in treatment-seeking seniors. [ABSTRACT FROM AUTHOR]

Background: Previous studies have yielded mixed results on the association between gender and alcohol use disorder (AUD) treatment outcomes. Thus, additional research is needed to determine the effect of gender on AUD treatment outcomes, including quality of life (QoL), particularly among older adults. Aims: In a clinical sample of older adults with DSM‐5 AUD, we examined changes in QoL from the beginning of AUD treatment through 1 year of follow‐ups. We also examined the effect of gender and explored interaction effects with gender on QoL. Methods: We utilized data from the "Elderly Study," a multi‐national, single‐blind, randomized, controlled trial of 693 adults aged 60+ with DSM‐5 AUD. Alcohol use was assessed with the Form‐90, and QoL with the brief version of the World Health Organization QoL measure. Information was collected at treatment initiation and at 4‐, 12‐, 26‐, and 52‐week follow‐ups. Multilevel mixed‐effects logistic and linear regression models were used to examine QoL changes and the effect of gender on changes in QoL. Results: Following treatment, small, but significant improvements were seen over time in overall perceived health (p < 0.05). Improvements that persisted over the 1‐year follow‐up period were seen in the QoL domains of physical health (β: 2.6, 95% CI: 1.4–3.9), psychological health (β: 3.5, 95% CI: 3.3–3.8), social relationships (β: 4.0, 95% CI: 2.5–5.6), and environmental health (β: 1.4, 95% CI: 0.4–2.4). No significant changes were seen over time in overall perceived QoL (p = 0.58). Gender was not associated with changes in any of the QoL outcome measures (all p ≥ 0.05). Conclusions: Among 60+ year‐old adults receiving treatment for DSM‐5 AUD, improvements in QoL were achievable and maintained over time, but were not associated with gender. [ABSTRACT FROM AUTHOR]

Depression and anxiety are highly prevalent among patients seeking outpatient treatment for alcohol use disorders (AUD) and if depression and anxiety are addressed the prognosis is improved. Screening instruments for depression and anxiety have been validated in populations suffering from drug use disorders, but not in populations suffering from AUD. The aim of this study was to validate four self-administrated screening instruments (PHQ-9, GAD-7, Kessler-6, and SRQ) and calculate the optimal cut-off value for identifying depression and anxiety. The study included 73 patients with self-reported depression or anxiety during AUD treatment. Each patient filled out the above-mentioned instruments and was subsequently interviewed by trained clinicians blinded to the results of the instruments with the Present State Examination to establish a diagnosis of depression or anxiety according to ICD-10. ROC curves were constructed for each instrument and the area under the curve (AUC) was calculated using patients with no depression or anxiety as reference. Youden's index was calculated to assess the optimal cut-off for each instrument. A total of 33 (45.2%) were diagnosed with depression or anxiety. The AUC for PHQ-9, GAD-7, Kessler-6, and SRQ were 0.767, 0.630, 0.793, and 0.698 respectively. Kessler-6, the instruments performing best based on the AUC, identified 27 (82%) of the 33 patients using a cut-off of 10 points. Kessler-6 seems to be valid and reliable in identifying patients requiring treatment for depression or anxiety among patients seeking treatment for AUD who are reporting depression or anxiety. [ABSTRACT FROM AUTHOR]

There is a lack of evidence for the consistency between self-reported alcohol consumption (SRAC) and concentrations of ethyl glucuronide in hair (hEtG) among elderly patients treated exclusively for alcohol use disorder (AUD). Hence, this study assessed the consistency between these two measures in these patients. A total of 190 patients with AUD were assessed for SRAC using Form 90 and hEtG, 14 or 22 weeks after treatment conclusion. Patients were grouped according to SRAC (g/day) and corresponding hEtG concentrations (pg/mg): 0 and <5 (abstinence), 0.1-14.3 and 5.0-9.9 (low consumption), 14.4-21.4 and 10.0-15.9 (moderate consumption), 21.5-59.9 and 16.0-30 (high consumption) and ≥60 and >30 (excessive consumption). The extent of underreporting and overreporting was examined by crosstabulations, and inter-rater reliability was reported by kappa correlations. Associations and effect modification were examined by conditional logistic regression. Due to multitesting, p-values ≤0.01 were considered significant. Underreporting was found in 96 patients (50.5%) and overreporting in 41 patients (21.6%). The kappa coefficients varied between 0.19 and 0.34. HEtG was more likely to detect low, moderate and high alcohol consumption compared with SRAC (ORs between 5.1 and 12.6, all p-values <0.01), but SRAC and hEtG did not differ significantly with respect to identification of abstinence (OR = 1.9, p = 0.05). Inconsistency between the outcome measures was found in a considerable number of the patients. More studies examining the consistency between SRAC and specific direct biomarkers of alcohol in this population seem warranted. [ABSTRACT FROM AUTHOR]

Background: Risk of relapse within the first months after alcohol use disorder (AUD) interventions is substantial among older adults. For this vulnerable group, little information exists on how this risk is associated with residual DSM‐5 AUD symptoms after treatment. Aims: To investigate among older adults who received short‐term treatment for DSM‐5 AUD (1) the prediction of drinking behaviors and quality of life 12 months after treatment initiation by 6‐month DSM‐5 AUD symptoms, AUD severity, and AUD remission, and (2) whether these DSM‐5 AUD indicators provide prognostic information beyond that gained from 6‐month alcohol use (AU) status. Methods: The international multicenter RCT "ELDERLY‐Study" enrolled adults aged 60+ with DSM‐5 AUD. We used data from the subsample of 323 German and Danish participants with complete DSM‐5 AUD criterion information 6 months after treatment initiation (61% male; mean age = 65.5 years). AU was assessed with Form 90, DSM‐5 AUD with the M.I.N.I., and quality of life with the WHOQOL‐BREF. Generalized linear models were applied to investigate the associations between 6‐month AUD indicators and 12‐month AU and quality of life. Results: Independent of AU at 6 months, having 1 (vs. no) residual AUD symptom at 6 months predicted a 12‐month "slip," defined as exceeding a blood alcohol concentration of 0.05% at least once during that time (OR: 3.7, 95% CI: 1.5 to 9.0), heavy episodic drinking, and hazardous use (p < 0.05). AUD remission was associated with a lower risk of a "slip" at 12 months (p < 0.05). Failed reduction/cessation was associated with poorer physical health (Coef.: −0.4, 95% CI −0.7 to −0.1). Conclusion: For older adults, residual AUD symptoms in the first months after short‐term treatment predict problematic AU outcomes during the first 12 months after treatment entry. Thus, residual symptoms should be addressed in this patient population during posttreatment screenings. [ABSTRACT FROM AUTHOR]

Background: The Oxford Hip Score is used to evaluate the outcome after total hip arthroplasty. The Oxford Hip Score was developed more than 20 years ago with only some degree of patient involvement. We question if the Oxford Hip Score is still relevant for the present-day total hip artrhoplasty patients. We aimed to determine whether the Oxford Hip Score contains items that are relevant for present-day patients with osteoarthritis undergoing total hip arthroplasty, thus investigating the content validity.Methods: Patients aged 60-75 years, undergoing total hip arthroplasty for primary osteoarthritis were recruited to participate in focus group interviews preoperatively and at 3 and 12 months after primary total hip arthroplasty. We conducted 6 focus group interviews in which 30 patients participated. The interviews were audio-recorded and transcribed verbatim. Using Interpretative Phenomenological Analysis, we inductively organised the interview transcripts into particular items/themes which we then compared to items in the Oxford Hip Score.Results: We identified 6 general items with 41 sub-items. The 6 general items were pain, walking, physical activities, functional abilities, quality of life and psychological health. We found that items in the Oxford Hip Score were all in some way relevant to the patients but that the Oxford Hip Score lacks several important items relevant for present-day total hip artrhoplasty patients, including several physical activities, functional abilities and certain aspects of quality of life and psychological health.Conclusion: We found that the Oxford Hip Score lacks important items for present-day patients in our population. Due to findings regarding several additional items that are not present in the Oxford Hip Score, particularly concerning physical activities and quality of life, we question the content validity of the Oxford Hip Score for a present-day population. Our findings indicate a need for a revision of the Oxford Hip Score. [ABSTRACT FROM AUTHOR]

Background: Alcohol Use Disorder (AUD) is a destructive and serious problem among indigenous populations around the world. The drinking pattern differs from the non-indigenous populations by being short-term risky drinking such as binge drinking. In general, the treatment offered is based on conventional western strategies, though, in many regions' treatment facilities are poor. The present review summarizes the researched possibilities for alcohol treatment specific to indigenous populations. Method: A systematic search in four databases, Pubmed, Psyinfo, Cochcrane and Cinahl within the past ten years identified 19 articles that investigate the effect of different approaches to treat indigenous people with AUD. Result: Several studies suggest implementing native and traditional ways of healing in the treatment. Community-driven approaches have shown effect in the reduction of AUD among indigenous youth, as well as a web based brief intervention, motivational interviewing, and alcohol restrictions. Also, naltrexone as firstline medical treatment is suggested. Discussion and conclusion: In general, the studies included have a moderate to low quality and are difficult to compare but can provide an overview of elements that seem important in the treatment of indigenous people. There is a lack of research of both conventional treatment and treatment specific tailored to indigenous populations. The latter specifically minded to community prevention, the involvement of local people and implementing cultural traditions and healing methods and rebuilding native identity, seems as important elements in future treatment and prevention strategies. [ABSTRACT FROM AUTHOR]

Background: Only a minority of individuals with problematic alcohol use ever seek alcohol treatment. Knowledge of general help‐seeking behavior in the healthcare system can identify possibilities for prevention and intervention. Method: The current study describes healthcare use, burden of disease, and prior morbidities over a 15‐year period by current alcohol use behavior among Danish adults aged 60–70. The Danish National Health Survey 2013 and the baseline assessment of the Elderly Study (2014–2016) were linked to Danish national registers to collect annual information on healthcare use and morbidity for the 15 years prior to inclusion. Participants from the 3 largest Danish municipalities were divided into 4 groups with varying drinking patterns and no recent treatment [12‐month abstinent (n = 691), low‐risk drinkers (n = 1978), moderate‐risk drinkers (n = 602), and high‐risk drinkers (n = 467)], and a group of treatment‐seeking individuals with a 12‐month DSM‐5 alcohol use disorder (AUD; n=262). Negative binomial regression models were utilized to compare rates of healthcare use and logistic regressions were used to compare odds of diagnoses. Results: Low‐, moderate‐, and high‐risk drinkers had similar rates of past healthcare utilization (low‐risk mean yearly number of contacts for primary care 7.50 (yearly range 6.25–8.45), outpatient care 0.80 (0.41–1.32) and inpatient care 0.13 (0.10–0.21)). Higher rates were observed for both the 12‐month abstinent group (adjusted RR = 1.16–1.26) and the group with AUD (ARR = 1.40–1.60) compared to the group with low‐risk alcohol consumption. Individuals with AUD had higher odds of previous liver disease (adjusted OR = 6.30), ulcer disease (AOR = 2.83), and peripheral vascular disease (AOR 2.71). Twelve‐month abstinence was associated with higher odds of diabetes (AOR = 1.97) and ulcer disease (AOR = 2.10). Conclusions: Looking back in time, we found that older adults had regular healthcare contacts, with those who received treatment for AUD having had the highest contact frequency and prevalence of alcohol‐related diseases. Thus, healthcare settings are suitable locations for efforts at AUD prevention and intervention. [ABSTRACT FROM AUTHOR]

Background: Studies have found that reductions in World Health Organization (WHO) drinking risk levels may be a stable outcome of treatment for alcohol use disorder (AUD) and associated with functional improvements. The aim of this study was to investigate whether posttreatment reductions in WHO drinking risk levels are stable over time among older adults and associated with a decrease in consequences of drinking and AUD symptoms and improved quality of life. Methods: Participants. Individuals 60+ years old, suffering from DSM‐5 AUD (n = 693), and seeking outpatient treatment. Measurements. WHO drinking risk levels, prior to treatment and at all follow‐up points up to 1 year after treatment start, were assessed with Form 90. Outcomes at follow‐up included consequences of drinking (Drinker Inventory of Consequences), quality of life (WHOQOL‐BREF), and DSM‐5 AUD symptoms (Mini International Neuropsychiatric Interview). Logistic regression and linear mixed models were used to examine the probability of maintaining risk‐level reductions at follow‐up and the association between risk‐level reductions and outcomes, respectively. Results: Reductions in risk levels were maintained over time (at least 1 level: OR 5.39, 95% CI 3.43, 8.47; at least 2 levels: OR 9.30, 95% CI 6.14, 14.07). Reductions were associated with reduced consequences of drinking and number of AUD symptoms, and minor, but statistically significant, improvements in quality of life. Conclusions: Maintaining reductions in WHO risk levels appears achievable for older adults seeking treatment for AUD. The small reduction of AUD symptoms and improvement of quality of life indicates that these reductions may not be adequate as the only treatment goal. [ABSTRACT FROM AUTHOR]

Background: Relatively little is known about the prognostic value of comorbid mental disorders in alcohol use disorder (AUD) treatment for older adults (OA).Aims: This article aimed to investigate 1) the impact of current unipolar mood and anxiety disorders in AUD treatment success in OA, 2) the timing of this putative comorbidity impact over six months, and 3) the role of treatment length in comorbidity effects.Methods: We analyzed baseline and one-, three-, and six-month follow-up data from the international multicenter RCT "ELDERLY-Study" (baseline n = 693, median age: 64.0 years) using mixed effects regression models. In adults aged 60+ with DSM-5 AUD "ELDERLY" compared outpatient motivational enhancement therapy (MET, four sessions) with outpatient MET plus community reinforcement approach for seniors (MET & CRA-S; up to 12 sessions). Aiming for abstinence or minimal alcohol use (AU), both conditions included CBT-elements. We assessed AU with Form 90, and mental disorders with the Mini International Neuropsychiatric Interview (M.I.N.I.).Results: Mood-related disorders were associated with more drinks per day at baseline and greater reductions in drinks per day at one and six months (main effect mood disorder: Coef. 2.1, 95% CI 0.6-3.6; one month interaction effect: Coef. -1.9, 95% CI -3.3- -0.5; six months interaction effect: Coef. -2.1, 95% CI -3.5 - -0.6). These results were replicated within MET & CRA-S but not within MET.Conclusion: Comorbid mental disorders had modest effects on short-term outpatient treatment outcomes. OA with AUD and unipolar mood-related disorders may profit from short interventions based on motivational interviewing and CBT-elements. ClinicalTrials.gov:NCT02084173. [ABSTRACT FROM AUTHOR]

Aims The objective of this paper was to examine 20-year trends of the socioeconomic status (SES) measures income and employment and their association with current alcohol use behaviors in Danish adults aged 60–70. Methods Data from The Danish National Health Survey 2013 and the baseline assessment of the Elderly Study (2013–2016) were combined to form four groups from the general population with various drinking patterns, but with no recent treatment for alcohol use disorder (AUD), and one group seeking treatment: Abstinent (n  = 691), low- (n  = 1978), moderate- (n  = 602), and high-risk (HR) drinkers (n  = 467), and DSM-5 AUD seeking treatment (n  = 262). For all groups, Danish national register data were linked at the individual level obtain find annual information on income and employment during the 20 years prior to interview. Mixed effects models were utilized to model trajectories of income and employment for the five groups. Results Lower income and employment status was observed from middle-aged adulthood when comparing 12-month abstinence or AUD to individuals with low or moderate alcohol consumption. At the end of the study period, moderate-risk drinkers experienced an increase, and HR drinkers a decrease, in income and rate of employment relative to the low-risk drinkers. Conclusions Alcohol use behaviors observed in older adults are related to distinct long-term trajectories regarding income and employment status, which are observable already in middle-aged adulthood. [ABSTRACT FROM AUTHOR]

The article presents the discussion on correction notice "Gender Differences in Alcohol Treatment."

Background: Although individuals with alcohol use disorder (AUD) have a significantly shorter lifespan than the general population, there is sparse evidence on cause of death when alcohol dependent people die prematurely. Especially the somatic causes of death are shed less light on.Aim: To determine the cause of premature death in individuals with AUD based on recent studies.Methods: This systematic review summarizes evidence from the last 10 years with cohort studies consisting of AUD patients with the subsequent outcome of cause of death and with at least two years of follow-up.Results: Nine studies were included of which only two were assessed to be of good quality. Furthermore, two studies were of moderately good and acceptable quality, respectively. This review found increased mortality in AUD individuals with the main causes of death being malignancy, and problems of the cardiovascular- and the digestive system.Conclusion: Malignancy was the most common cause of death in the included AUD cohorts, but the overall quality of the included studies in this review is low. There is a need for high-quality studies to better understand cause-specific mortality among AUD individuals. [ABSTRACT FROM AUTHOR]

Exercise based treatment for alcohol use disorders have shown an impact on mental health (e.g., depression or anxiety), and alcohol outcomes (e.g., craving or abstinence). However, there is a lack of information on the role of motivational aspects of participation in the process of designing exercise interventions for alcohol use disorder. This study aims to examine: (1) whether motivational aspects are taken into account when the type and delivery method of exercise interventions are chosen; (2) whether motivational aspects are taken into account post intervention; and (3) whether there are different traditions regarding payment for participants. A systematic search was conducted to identify eligible studies in order to investigate the impact of motivational aspects including payment for participation. Twelve samples including ten to 620 participants were investigated. Participants were predominantly male and in their 40s, ranging from 20 to 69 years. Aerobic exercise (running, walking, fitness) either in a group or individual condition is the most frequently used exercise form. Two studies included ball games or cycling, while only one study offered the opportunity to choose between a wide range of sports. Motivational aspects are mentioned explicitly in half of the studies, mostly with regard to adherence to participation and social integration as the reason for using a group condition. Achievement is mentioned in two studies but not explicitly with regard to planning the intervention design. Five studies include payment for participation in exercise. Findings of the present study identify that motivational aspects for participation are rarely involved in the planning of an exercise intervention. With regard to the specific psychosocial vulnerability of an alcohol use disorder population, this should be an important aspect of further research studies. [ABSTRACT FROM AUTHOR]

Background: The proportion of 60+ years with excessive alcohol intake varies in western countries between 6–16 % among men and 2–7 % among women. Specific events related to aging (e.g. loss of job, physical and mental capacity, or spouse) may contribute to onset or continuation of alcohol use disorders (AUD). We present the rationale and design of a multisite, multinational AUD treatment study for subjects aged 60+ years. Methods/Design: 1,000 subjects seeking treatment for AUD according to DSM-5 in outpatient clinics in Denmark, Germany, and New Mexico (USA) are invited to participate in a RCT. Participants are randomly assigned to four sessions of Motivational Enhancement Treatment (MET) or to MET plus an add-on with eight sessions based on the Community Reinforcement Approach (CRA), which include a new module targeting specific problems of older adults. A series of assessment instruments is applied, including the Form-90, Alcohol Dependence Scale, Penn Alcohol Craving Scale, Brief Symptom Inventory and WHO Quality of Life. Enrolment will be completed by April 2016 and data collection by April 2017. The primary outcome is the proportion in each group who are abstinent or have a controlled use of alcohol six months after treatment initiation. Controlled use is defined as maximum blood alcohol content not exceeding 0.05 % during the last month. Total abstinence is a secondary outcome, together with quality of life and compliance with treatment. Discussion: The study will provide new knowledge about brief treatment of AUD for older subjects. As the treatment is manualized and applied in routine treatment facilities, barriers for implementation in the health care system are relatively low. Finally, as the study is being conducted in three different countries it will also provide significant insight into the possible interaction of service system differences and related patient characteristics in prediction of treatment outcome. [ABSTRACT FROM AUTHOR]

Background: Around 585,000 people in Denmark engage in harmful use of alcohol with 140,000 suffering from outright alcohol dependence. The concerned significant others (CSOs) are affected by the drinking, often suffering almost as much as the person with alcohol use disorder. Community Reinforcement and Family Training (CRAFT) is aimed at CSOs who struggle unsuccessfully, in an effort to motivate their loved ones to stop drinking and seek treatment. The aims of this study are 1) To implement CRAFT interventions into the daily routine of operating Danish alcohol treatment centers 2) To investigate whether 6-week-individual CRAFT, 6-week-open group-based CRAFT or CRAFT based on self-help material, is efficient in getting problem drinkers to seek treatment for their alcohol problems 3) To investigate which of the three interventions (individual, group or self-directed CRAFT) is the most effective and in which group of population.Methods: The study is a three-arm, cluster randomized controlled trial: A: individual CRAFT, group CRAFT, and CRAFT as a self-help intervention. A total of 405 concerned significant others to persons with alcohol abuse will be recruited from 24 alcohol outpatient clinics. The participants will fill out a questionnaire regarding i.e. life quality, if the drinking person entered treatment (main outcome) and satisfaction with the intervention, at baseline and after 3 and 6 months.Discussion: We expect to establish evidence as to whether CRAFT is efficient in a Danish treatment setting and whether CRAFT is most effective at individual, group or self-help material only.Trial Registration: Clinical trials.gov ID: NCT03281057 . Registration date: September 13th, 2017. [ABSTRACT FROM AUTHOR]