Change in DSM‐5 Alcohol Use Disorder Criteria Count and Severity Level as a Treatment Outcome Indicator: Results from a Randomized Trial. (21st June 2018)

• Record Type: Journal Article
• Authors: Kiluk, Brian D.; Frankforter, Tami L.; Cusumano, Michelle; Nich, Charla; Carroll, Kathleen M.
• Is Part Of: Alcoholism. Volume 42:Number 8(2018)
• Page Start: 1556
• Page End: 1563
• Publication Date: 2018-06-21
• Subjects: DSM‐5 -- Alcohol Use Disorder -- Criteria Count -- Severity Category -- Treatment Outcome Indicator; Alcoholism -- Periodicals; Alcoholism -- Periodicals; Alcoolisme; Electronic journals; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.861005
• DOI: 10.1111/acer.13807
• Languages: English
• ISSNs: 0145-6008

Abstract

Abstract : Background: Most clinical trials evaluating treatments for alcohol use target individuals meeting diagnostic criteria for alcohol use disorder (AUD), but few address change in diagnostic status following treatment or as a potential outcome indicator. This study evaluated whether DSM‐5 AUD total criteria count or severity category was sensitive to change over time and treatment effects. Methods: Data were drawn from a randomized clinical trial that evaluated the efficacy of computer‐based cognitive behavioral therapy program (CBT4CBT) for AUD. Sixty‐eight individuals were randomized to 1 of the 3 weekly outpatient treatments for an 8‐week period: (i) treatment as usual (TAU), (ii) TAU+CBT4CBT, and (iii) CBT4CBT+brief monitoring. Structured clinical interviews were used to determine current (past 30 days) AUD diagnosis at baseline, end‐of‐treatment, and 6 months following end‐of‐treatment. Change in the total number of DSM criteria endorsed, as well as severity categories (mild, moderate, severe), was evaluated across time and by treatment condition. Results: Generalized Poisson's linear mixed models revealed a significant reduction in the number of DSM criteria from baseline to treatment end point [time effect χ 2 (1) = 35.54, p < 0.01], but no significant interactions between time and treatment condition. Fewer total criteria endorsed, as well as achieving at least a 2‐level reduction in AUD severity category at end‐of‐treatment, were associated with better outcomes during follow‐up. Chi‐square results indicated a greater proportion of individuals assigned to TAU+CBT4CBT had at least a 2‐level reduction in severity category compared to TAU, at trend‐level significance [ χ 2 (2, 54) = 5.13, p = 0.07], consistent with primary alcohol use outcomes in the main trial. Conclusions: This is the first study to demonstrate change in DSM‐5 AUD total criteria count, as well as severity category, in a randomized clinical trial. These findings offer support for their use as a potential clinically meaningful outcome indicator. Abstract : In a randomized trial evaluating the efficacy of computer‐based treatment for alcohol use disorder (AUD) that included repeated assessment of DSM‐5 diagnostic criteria, we found a significant reduction in the number of DSM criteria endorsed, as well as a reduction in AUD severity category from baseline to treatment end‐point. These reductions were associated with better outcomes at follow‐up. This study offers support for change in DSM‐5 AUD total criteria count and severity category as a clinically meaningful outcome.