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      Internet‐based therapy versus face‐to‐face therapy for alcohol use disorder, a randomized controlled non‐inferiority trial

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          Abstract

          Background and aims

          Most people with alcohol use disorder (AUD) are never treated. Internet‐based interventions are effective in reducing alcohol consumption and could help to overcome some of the barriers to people not seeking or receiving treatment. The aim of the current study was to compare internet‐delivered and face‐to‐face treatment among adult users with AUD.

          Design

          Randomized controlled non‐inferiority trial with a parallel design, comparing internet‐delivered cognitive–behavioural therapy (ICBT) ( n = 150) with face‐to‐face CBT ( n = 151), at 3‐ and 6‐month follow‐ups.

          Setting

          A specialized clinic for people with AUD in Stockholm, Sweden. Participants were recruited between 8 December 2015 and 5 January 2018.

          Participants

          A total of 301 patients [mean age 50 years, standard deviation (SD) = 12.3] with AUD, of whom 115 (38%) were female and 186 (62%) were male.

          Intervention and comparator

          Participants were randomized in blocks of 20 at a ratio of 1 : 1 to five modules of therapist‐guided ICBT or to five modules of face‐to‐face CBT, delivered over a 3‐month period. The same treatment material and the same therapists were used in both groups.

          Measurements

          The primary outcome was standard drinks of alcohol consumed during the previous week at 6‐month follow‐up, analysed according to intention‐to‐treat. The pre‐specified non‐inferiority limit was five standard drinks of alcohol and d = 0.32 for secondary outcomes.

          Results

          The difference in alcohol consumption between the internet and the face‐to‐face group was non‐inferior in the intention‐to‐treat analysis of data from the 6‐month follow‐up [internet = 12.33 and face‐to‐face = 11.43, difference = 0.89, 95% confidence interval (CI) = −1.10 to 2.88]. The secondary outcome, Alcohol Use Disorder Identification Test score, failed to show non‐inferiority of internet compared with face‐to‐face in the intention‐to‐treat analysis at 6‐month follow‐up (internet = 12.26 and face‐to‐face = 11.57, d = 0.11, 95% CI = –0.11 to 0.34).

          Conclusions

          Internet‐delivered treatment was non‐inferior to face‐to‐face treatment in reducing alcohol consumption among help‐seeking patients with alcohol use disorder but failed to show non‐inferiority on some secondary outcomes.

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          Most cited references 49

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

            Purpose This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure. Methods EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument’s sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions. Results Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording ‘slight-moderate-severe’ problems, with anchors of ‘no problems’ and ‘unable to do’ in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states. Conclusions A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.
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              Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

              Summary Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. Funding Bill & Melinda Gates Foundation.
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                Author and article information

                Contributors
                magnus.johansson.1@ki.se
                Journal
                Addiction
                Addiction
                10.1111/(ISSN)1360-0443
                ADD
                Addiction (Abingdon, England)
                John Wiley and Sons Inc. (Hoboken )
                0965-2140
                1360-0443
                13 October 2020
                May 2021
                : 116
                : 5 ( doiID: 10.1111/add.v116.5 )
                : 1088-1100
                Affiliations
                [ 1 ] Department of Global Public Health Karolinska Institutet Stockholm Sweden
                [ 2 ] Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
                [ 3 ] Stockholm Health Care Services Stockholm County Council Stockholm Sweden
                [ 4 ] Department of Psychology Uppsala University Uppsala Sweden
                Author notes
                [*] [* ] Correspondence to: Magnus Johansson, Department of Global Public Health, Karolinska Institutet, Riddargatan 1 – mottagningen för alkohol och hälsa, Riddargatan 1. SE‐114 35 Stockholm 171 77, Sweden. E‐mail: magnus.johansson.1@ 123456ki.se
                Article
                ADD15270 ADD-20-0279.R2
                10.1111/add.15270
                8247312
                32969541
                33c6db03-fcbb-49c3-8d7c-0a4cd289c2b1
                © 2020 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of the Society for the Study of Addiction

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                Page count
                Figures: 2, Tables: 4, Pages: 13, Words: 5670
                Product
                Funding
                Funded by: Karolinska Institutet , open-funder-registry 10.13039/501100004047;
                Award ID: Doctoral School in Health Care Sciences 2014
                Funded by: Stockholms Läns Landsting , open-funder-registry 10.13039/501100004348;
                Award ID: ALF20130688
                Award ID: ALF20150322
                Funded by: eSupport unit of Stockholm Center for Dependency Disorders
                Categories
                Research Report
                Research Reports
                Custom metadata
                2.0
                May 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:01.07.2021

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