ABSTRACT
Background: Controlled drinking is an attractive treatment goal among a large proportion of individuals with alcohol use disorder (AUD), with Behavioral Self-control Training (BSCT) as the most established treatment intervention, for this purpose. Yet, few controlled trials have aimed at investigating the efficacy of interventions with controlled drinking as treatment goal, and the implementation of these treatments in addiction care is scarce. Methods: A multi-site randomized controlled parallel superiority trial compared the efficacy of BSCT (5 sessions) to the active comparator Motivational Enhancement Therapy (MET) (4 sessions). A sample of 250 patients fulfilling criteria for AUD (DSM 5) with a goal of controlled drinking were included. As a result of the covid pandemic, a total of 76 participants received treatment via video meeting instead of face-to-face. Follow-ups were conducted at 12- and 26 weeks after inclusion. Primary outcome measure was mean weekly alcohol consumption. Treatment effects were analyzed by linear mixed-models. Results: Both treatment arms showed significant treatment effects for the primary outcome as well as binge drinking days (BDD) and measures of alcohol-related harm at 26 weeks after inclusion. There were no significant differences between treatment groups for the primary outcome. A total of 41,6 % of the patients obtained a level of low-risk drinking at the 26-week follow-up (9/14 standard drinks of 12 g of alcohol for women/men). No significant differences based on how the treatment was delivered i.e., between the face-to-face or video based intervention were detected. A subgroup of individuals (n = 25) with 75% or more of BDD before inclusion, reduced their drinking to 29% BDD at the 26-week follow-up. Conclusions: These results suggest that BSCT and MET designed as short-term treatments, are efficacious for a wide range of patients with AUD. This is evident in that a substantial proportion of patients obtained low-risk drinking levels, and individuals with more heavy consumption patterns, also significantly reduced their consumption. These results highlight a need for a more diverse approach within health care services to recovery from AUD with possibility of offering psychological treatments with controlled drinking as a treatment goal.
ABSTRACT
BACKGROUND AND AIMS: People who inject drugs may be particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to underlying health problems, stigma and social vulnerabilities. Harm reduction services, including needle exchange programs (NEP), have been subjected to varying degrees of disruption in the world, especially in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Compared to responses in other countries, Sweden's initial strategy toward limiting the spread and impact of COVID-19 was less restrictive to its citizens with no imposed general societal lockdown. In this study, we investigate changes in drug use patterns, utilization of NEP associated health services, COVID-19 health literacy and the prevalence of SARS-CoV-2 antibodies among NEP clients in Stockholm during the COVID-19 pandemic. METHODS: NEP visits and services provided (needles/syringes, HIV and hepatitis C tests and treatment, naloxone distributed) and overall mortality among NEP clients between January 1 and October 31, 2020, were used for trend analyses in comparison with corresponding 2019 data. Between July 27 and October 2, 2020, NEP clients (n = 232) responded to a 27 item COVID-19 Health Literacy Questionnaire. SARS CoV-2 IgG antibody tests (n = 779) were performed between June 15 and October 31, 2020. RESULTS: During the COVID-19 pandemic number of clients, client visits, naloxone distribution and HCV tests remained stable compared to 2019, while distribution of needles/syringes increased (p < 0.0001); number of HIV tests and HCV treatments decreased (p < 0.05); and mortality decreased (< 0.01). Overall, the level of health literacy concerning transmission routes and protective measures was high. SARS-CoV-2 antibody prevalence was 5.4% (95% CI 4.0-7.2). CONCLUSIONS: The Stockholm NEP managed to maintain a high level of clients and services during the pandemic. In general, COVID-19 health literacy was adequate and the overall SARS-CoV-2 antibody prevalence was low compared to the general population, which highlights a need for prioritized and targeted COVID-19 vaccination among PWID.