Effect of Cognitive Bias Modification on Early Relapse Among Adults Undergoing Inpatient Alcohol Withdrawal Treatment A Randomized Clinical Trial
Effect of Cognitive Bias Modification on Early Relapse Among Adults Undergoing Inpatient Alcohol Withdrawal Treatment A Randomized Clinical Trial
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DOI：
10.1001/jamapsychiatry.2020.3446
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发表时间：
2020-11-04
期刊：
影响因子：
25.8
通讯作者：
Verdejo-Garcia, Antonio
中科院分区：
文献类型：
--
作者：
Manning, Victoria;Garfield, Joshua B. B.;Verdejo-Garcia, Antonio
重要性接受住院戒断治疗的酒精使用障碍患者中，有一半以上在出院后几周内复发，阻碍了随后的吸收和心理和药物干预的有效性。认知偏差修正(CBM)改善了酒精康复后的结果，但在戒断治疗期间提供CBM的有效性尚未确定。目的为了验证CBM会增加住院戒断治疗后2周内戒酒可能性的假设。设计、设置和参与者进行了一项随机临床试验，在2017年6月4日至2019年7月14日期间，对澳大利亚墨尔本4个住院戒断单元的950名患者进行了资格筛选，以接受CBM或假治疗。年龄在18岁到65岁之间的中度或重度酒精使用障碍患者，没有神经系统疾病或创伤性脑损伤，都符合条件。研究人员对参与者的情况视而不见，进行了为期两周的跟踪调查，这是主要的终点。两个方案都进行了意向治疗分析。干预被随机分为连续4次的CBM每日会议，旨在减少酒精接近偏见或非旨在改变接近偏见的假训练。主要结果和措施通过时间线回访来评估戒断。参与者被分类为戒酒(出院后前14天内不饮酒)或复发(出院后前14天内曾饮酒或失去随访)。结果在950名符合资格的患者中，338人不符合纳入标准，108人在接受治疗前出院，192人拒绝。在312名同意的患者中(参考样本)，12名患者在随机分组之前退出。在300名随机的最终人群中(CBM，n=147；Sham，n=153)，248人完成了干预，272人完成了随访。在300名参与者(173名[57.7%]男性；平均年龄43.47[10.43]岁)中，7名患者(3名对照组，4名CBM)在发现训练不舒服后退出。对照组戒断率为42.5%(95%CI，34.3%~50.6%)，CBM组戒断率为54.4%(95%CI，46.0%~62.8%)，两者差异有11.9%(95%CI，0.04%~23.8%；P=0.04)。在仅包括完成4次训练和随访的患者的按方案分析中，两组之间的戒断率差异为17.0%(95%CI，3.8%-30.2%；P=0.008)。结论和相关性本临床试验的结果支持CBM治疗酒精使用障碍的有效性。CBM安全且易于实施，只需要一台计算机和操纵杆，不需要专业人员/培训，可以在戒断治疗期间作为辅助干预常规提供，以优化结果。
IMPORTANCE More than half of patients with alcohol use disorder who receive inpatient withdrawal treatment relapse within weeks of discharge, hampering subsequent uptake and effectiveness of psychological and pharmacologic interventions. Cognitive bias modification (CBM) improves outcomes after alcohol rehabilitation, but the efficacy of delivering CBM during withdrawal treatment has not yet been established.OBJECTIVE To test the hypothesis that CBM would increase the likelihood of abstaining from alcohol during the 2 weeks following discharge from inpatient withdrawal treatment.DESIGN, SETTING, AND PARTICIPANTS In a randomized clinical trial, 950 patients in 4 inpatient withdrawal units in Melbourne, Australia, were screened for eligibility between June 4, 2017, and July 14, 2019, to receive CBM or sham treatment. Patients with moderate or severe alcohol use disorder aged 18 to 65 years who had no neurologic illness or traumatic brain injury were eligible. Two-week follow-up, conducted by researchers blinded to the participant's condition, was the primary end point. Both per-protocol and intention-to-treat analysis were conducted.INTERVENTIONS Randomized to 4 consecutive daily sessions of CBM designed to reduce alcohol approach bias or sham training not designed to modify approach bias.MAIN OUTCOMES AND MEASURES Primary outcome was abstinence assessed using a timeline followback interview. Participants were classified as abstinent (no alcohol use in the first 14 days following discharge) or relapsed (any alcohol use during the first 14 days following discharge or lost to follow-up).RESULTS Of the 950 patients screened for eligibility, 338 did not meet inclusion criteria, 108 were discharged before being approached, and 192 refused. Of the 312 patients who consented (referred sample), 12 withdrew before being randomized. In the final population of 300 randomized patients (CBM, n = 147; sham, n = 153), 248 completed the intervention and 272 completed the follow-up. Of the 300 participants (173 [57.7%] men; mean [SD] age, 43.47 [10.43] years), 7 patients (3 controls, 4 CBM) withdrew after finding the training uncomfortable. Abstinence rates were 42.5% (95% CI, 34.3%-50.6%) in controls and 54.4% (95% CI, 46.0%-62.8%) in CBM participants, yielding an 11.9% (95% CI, 0.04%-23.8%; P = .04) difference in abstinence rates. In a per-protocol analysis including only those who completed 4 sessions of training and the follow-up, the difference in abstinence rate between groups was 17.0% (95% CI, 3.8%-30.2%; P = .008).CONCLUSIONS AND RELEVANCE The findings of this clinical trial support the efficacy of CBM for treatment of alcohol use disorder. Being safe and easy to implement, requiring only a computer and joystick, and needing no specialist staff/training, CBM could be routinely offered as an adjunctive intervention during withdrawal treatment to optimize outcomes.