Citation

Stout RL, Braciszewski JM, Subbaraman MS, Kranzler HR, O'Malley SS, Falk D. Addiction 2014; 109(12): 2044-2052.

Affiliation

Decision Sciences Institute, Pacific Institute for Research and Evaluation, Pawtucket, RI, USA.

Copyright

(Copyright © 2014, John Wiley and Sons)

DOI

10.1111/add.12700

PMID

25098969

Abstract

AIMS: We use intensive longitudinal data methods to illuminate processes affecting patients' drinking in relation to the discontinuation of medications within an alcohol treatment study. Although previous work has focused on broad measures of medication adherence, we focus on dynamic changes in drinking both before and after patients discontinue.

DESIGN: We conducted secondary data analyses using the COMBINE study, focused on participants who discontinued medications prior to the planned end of treatment. Using an interrupted timeseries analysis, we analyzed drinking in the weeks before and after discontinuation and also studied outcomes at the end of the COMBINE follow-up. SETTING: Unites States of America. PARTICIPANTS: We describe the sub-sample of COMBINE participants who discontinued medications (n=450), and compare them with those who were medication adherent (n=559) and with those who discontinued but had substantial missing data (n=217). MEASUREMENTS: The primary outcomes were percent days abstinent (PDA) and percent heavy drinking days (PHDD). Medication adherence data were used to approximate the date of discontinuation.

FINDINGS: For many patients, an increase in drinking began weeks before discontinuation (PDA: F(1,4803) = 19.07, p <.001; PHDD: F(1,4804) = 8.58, p =.003) then escalated at discontinuation (PDA: F(1,446) = 5.05, p =.025; PHDD: F(1,446) = 4.52, p =.034). Among other effects, the amount of change was moderated by the reason for discontinuation (e.g., adverse event; PDA: F(2,4803) = 3.85, p =.021; PHDD: F(2,4804) = 5.36, p =.005) and also whether it occurred in the first or second half of treatment (PDA: F(1,4803) = 5.23, p =.022; PHDD: F(1,4804) = 8.79, p =.003).

CONCLUSIONS: A patient's decision to stop taking medications during alcohol treatment appears to take place during a weeks-long process of disengagement from treatment. Patients who discontinue medications early in treatment or without medical consultation appear to drink more frequently and more heavily.

Language: en