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Research ArticleOriginal Research

An Intervention for Treating Alcohol Dependence: Relating Elements of Medical Management to Patient Outcomes With Implications for Primary Care

Denise B. Ernst, Helen M. Pettinati, Roger D. Weiss, Dennis M. Donovan and Richard Longabaugh
The Annals of Family Medicine September 2008, 6 (5) 435-440; DOI: https://doi.org/10.1370/afm.884
Denise B. Ernst
PhD
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Helen M. Pettinati
PhD
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Roger D. Weiss
MD
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Dennis M. Donovan
PhD
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Richard Longabaugh
EdD
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Article Figures & Data

Tables

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    Table 1.

    Patient-Level Adherence Measures: Attendance, Working Alliance With Clinician, Patient Satisfaction, and Patient Drinking Outcomes

    VariableNMeanSDMinMax
    Max = maximum; min = minimum.
    a Higher scores indicate stronger alliance; sum of responses on 12 questions on a scale of 1–7.
    b Lower scores indicate greater satisfaction; sum of responses on 3 questions on a scale of 1–3.
    Medical management visits1,1627.82.4117
    Medical management clinicians seen1,1621.30.513
    Patient’s total time spent in Medical Management visits, min1,1621856430450
    Patient Working Alliance Inventory score 4 weeks into Medical Management treatmenta97265.868.562484
    Patient end-of-treatment satisfaction with Medical Management scoreb9235.71.4315
    Days abstinent in each of months 1–4 of treatment, mean %1,08676280100
    Days heavy drinking in each of months 1–4 of treatment, mean %1,08615220100
    • View popup
    Table 2.

    Clinician- and Patient-Level Predictors of Patient Days Abstinent (n = 813), Days of Heavy Drinking During Medical Management (n = 813), and Clinical Improvement at the End of Treatment (n = 797)

    OutcomeParameter EstimateSEPValue
    MM=Medical Management; SE=standard error.
    Days abstinent, mean %
        Intercept76.82941.4001<.0001
        Clinician mean authoritative score34.600413.7917.0172
        Clinician mean strict adherence scorea−40.178015.1000.0119
        Patient number of visits4.3219.7739<.0001
        Patient total minutes in Medical Management visits−.0555.01974.0014
        Patient baseline days abstinent, %.2164.0350<.0001
        Patient working alliance score for Medical Management.3541.1102.0014
        Patient satisfaction score with Medical Management treatment−2.1368.7120.0028
    Days heavy drinking, %
        Intercept14.5775.8941<.0001
        Clinician mean authoritative score−18.40358.9239.0471
        Clinician mean strict adherence scorea28.58269.6938.0058
        Patient number of visits−4.0094.5618<.0001
        Patient total minutes in Medical Management visits.04592.01403.0011
        Patient baseline days heavy drinking, %.09392.02252<.0001
        Patient working alliance score for Medical Management−.2223.08151.0065
        Patient satisfaction score with Medical Management treatmentb.9113.5258.0835
    Clinical improvement
        Intercept.6256.02301<.0001
        Clinician mean authoritative score.5687.2297.0186
        Clinician mean strict adherence score−.3890.2480.1263
        Patient number of visits.06682.01475<.0001
        Patient total minutes in Medical Management visits−.00126.0004.0006
        Patient baseline clinical composite index−.08436.03681.0222
        Patient working alliance score for Medical Management.002176.002138.3091
        Patient satisfaction score with Medical Management treatment−.02877.01391.0389

Additional Files

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  • The Article in Brief

    An Intervention for Treating Alcohol Dependence: Relating Elements of Medical Management to Patient Outcomes With Implications for Primary Care

    Denise B. Ernst , and colleagues

    Background This study examines factors in the relationship between patient, clinician, and treatment results in a program to treat alcohol dependence. The program, conducted in sites affiliated with academic alcohol research programs, has found that patients who receive the drug naltrexone plus a Medical Management approach significantly reduce their drinking. (In the Medical Management approach, patients work with a clinician to learn about alcohol dependence, develop treatment and follow-up plans, and monitor their progress).

    What This Study Found Patients who attend more visits reduce their drinking and have better clinical results. Patients' positive views of the relationship with their clinician, as well as their satisfaction with treatment, predict more days of abstinence from alcohol during treatment. In this study, participating clinicians were generally warm and informative, provided direction, and followed and completed the study plan. They help improve patient results if they show confidence in the treatment and are flexible in delivering it.

    Implications

    • This approach to alcohol treatment may be suitable for the primary care setting.
    • Using effective medications and managing alcohol dependence in primary care could make treatment more available and lower the stigma related to asking for and receiving treatment for alcohol problems.
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The Annals of Family Medicine: 6 (5)
The Annals of Family Medicine: 6 (5)
Vol. 6, Issue 5
1 Sep 2008
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An Intervention for Treating Alcohol Dependence: Relating Elements of Medical Management to Patient Outcomes With Implications for Primary Care
Denise B. Ernst, Helen M. Pettinati, Roger D. Weiss, Dennis M. Donovan, Richard Longabaugh
The Annals of Family Medicine Sep 2008, 6 (5) 435-440; DOI: 10.1370/afm.884

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An Intervention for Treating Alcohol Dependence: Relating Elements of Medical Management to Patient Outcomes With Implications for Primary Care
Denise B. Ernst, Helen M. Pettinati, Roger D. Weiss, Dennis M. Donovan, Richard Longabaugh
The Annals of Family Medicine Sep 2008, 6 (5) 435-440; DOI: 10.1370/afm.884
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