Reductions in Alcohol Craving Following Naltrexone Treatment for Heavy Drinking.

AIMS: The role of craving for alcohol as a response to alcohol treatment is not well understood. We examined daily diary ratings of craving over the course of 28 days among individuals participating in an inpatient substance abuse treatment program. METHODS: Participants were alcohol dependent patients (n = 100) in the Hazelden residential treatment program who were offered and agreed to take naltrexone and an age- and gender-matched comparison group (n = 100) of alcohol-dependent patients in the same program who declined the offer of treatment with naltrexone. Changes in craving over time were compared between the two groups. RESULTS: The naltrexone-treated group reported a more rapid decrease in craving than the usual care group. CONCLUSIONS: The change in the trajectory of craving is consistent with prior reports suggesting that craving reduction is a mechanism of naltrexone's efficacy in treating alcohol dependence. Providing naltrexone to individuals seeking treatment for alcohol dependence may accelerate a reduction in their craving, consistent with a primary target of many addiction treatment programs. SHORT SUMMARY: Craving ratings by 100 residential patients taking naltrexone for alcohol dependence were compared to ratings by 100 patients who did not take naltrexone. Craving for alcohol decreased more rapidly in the patients taking naltrexone. Providing naltrexone to individuals seeking treatment for alcohol dependence may accelerate a reduction in craving, which may benefit treatment efforts.

Outpatient follow-up after psychiatric hospitalization for depression and later readmission and treatment adequacy.

OBJECTIVE: The study evaluated whether timely postdischarge follow-up, a health system quality indicator, corresponded with improved longer-term posthospital care for depression. METHODS: The authors assessed outpatient mental health encounters, including telephone contact, within seven days of discharge among 56,785 Veterans Health Administration patients with an inpatient stay for major depression between 2005 and 2010. They also assessed readmission rates, antidepressant medication coverage, and psychotherapy visits for 90 days following discharge. RESULTS: The percentage of patients who received outpatient follow-up within seven days of discharge increased from 39% to 75%. After adjustment for patient characteristics, patients were more likely to receive adequate psychotherapy in 2010 than in 2005 (odds ratio=1.29, 95% confidence interval=1.19-1.40). There were no significant changes in readmission or antidepressant treatment. CONCLUSIONS: Timely outpatient follow-up after hospitalization may not reduce readmission or substantially improve longer-term depression treatment, suggesting a need for additional or more effective care processes.

Using the addiction severity index to predict mental and medical health service utilization.

This study assessed the utility of adding the Addiction Severity Index (ASI) to demographic and clinical diagnostic information for the purpose of predicting subsequent substance use disorder service use, and use of other healthcare services by 260 veterans admitted for outpatient substance use disorder treatment. Data collected included demographics, clinical diagnoses, assessment data from the ASI, as well as measures of six-month health service utilization (e.g., substance use disorder services, other mental health services, outpatient medical visits, urgent care visits, inpatient psychiatric and medical). Multivariate analysis using Tobit regression models showed six out of seven ASI scales were significant predictors, and that combining ASI data with demographics and clinical data significantly improved prediction of health care services. It also was found that certain psychiatric and medical diagnoses were related to service use measures, and that a diagnosis of depression was related to overall healthcare utilization.