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Research Updates: Addiction Treatment Models and E-Cigarettes

Research Updates

TREATMENT MODELS

Chronic Care Management Doesn’t Improve Outcomes.

The Addiction Health Evaluation and Disease Management (AHEAD) study, a randomized trial involving 563 participants with alcohol and/or drug dependence, was recently completed at a hospital-based primary care clinic at Boston Medical Center.

The Addiction Health Evaluation and Disease Management (AHEAD) study, a randomized trial involving 563 participants with alcohol and/or drug dependence, was recently completed at a hospital-based primary care clinic at Boston Medical Center.

The findings were both surprising and discouraging: CCM did not improve addiction outcomes or health care utilization.

About half of the participants (n=282) were assigned to receive CCM, while the other half (n=281) received an appointment with a primary care physician and a list of addiction treatment resources. The CCM team consisted of a nurse care manager, social worker, internists and a psychiatrist with addiction expertise.

Patients in the intervention group were offered a wide range of services tailored to their needs: motivational enhancement therapy, relapse prevention counseling, addiction pharmacotherapy, and substance abuse treatment. Care was flexibly delivered via scheduled clinic appointments, by telephone, on a dropin basis, and by 24-hour pager. Patients were followed for one year.

Patients received payment at various time points during the study. They were also offered a meal and reimbursement for transportation to each visit. Not surprisingly, patient retention was very high (95% at 12 months).

AHEAD’s primary outcome was self-reported abstinence from alcohol and other drugs. Forty-four percent of patients in the CCM group were abstinent at study completion compared to 42% in the control group (difference not statistically significant). There were no differences for a host of secondary measures: addiction severity, health-related quality of life, emergency department visits, and hospitalizations. No financial data were presented, however, one can assume that the CCM infrastructure was costly.

The researchers offered various explanations for CCM’s lack of apparent benefit but ultimately concluded, “low intervention potency seems an unlikely explanation for the results” (Saitz R et al, JAMA 2013;310(11):1156–1167).

CATR’s Take: Addiction is a chronic, relapsing-remitting disease. This investigation, the most rigorous to date, severely challenges the efficacy of CCM for substance use disorders. The authors appropriately noted that perhaps, “not all chronic diseases are the same and that CCM may not have the same effect across conditions for which complexity varies.” Although further research is clearly warranted, CCM is not yet ready for prime time in general community settings.

NICOTINE

Still Waiting for Good Data on Electronic Cigarettes

Can electronic cigarettes, commonly referred to as e-cigarettes, play a role in helping people quit smoking tobacco? A group of researchers in New Zealand conducted a randomized controlled trial to see if e-cigarettes, which deliver nicotine and can reduce nicotine withdrawal, were as effective as nicotine patches in promoting abstinence.

E-cigarettes are battery-powered devices that vaporize nicotine for inhalation. The researchers randomly assigned 657 adult smokers wanting to quit to one of three groups: 1) nicotine e-cigarettes, as needed; 2) nicotine patches, 21 mg per day; and 3) placebo e-cigarettes, as needed. Study participants could also call a national Quitline, a telephone counseling service, but received no other support in their effort to quit smoking.

The investigators performed several experiments to estimate the amount of nicotine delivered by the e-cigarettes. The e-cigarettes used cartridges that were found to contain 10–16 mg of nicotine. Three hundred puffs of vapor from these cartridges yielded a total of 3–6 mg of nicotine.

Study subjects could use their assigned product for one week prior to and 12 weeks after their quit dates. The primary outcome was six months of continuous abstinence, which was biochemically verified by measuring exhaled carbon monoxide. Just over 7% of participants in the nicotine e-cigarette group had sustained abstinence compared to 5.8% of participants using nicotine patch and 4.1% in the placebo e-cigarette group. Differences between groups were not statistically significant but the authors acknowledged the study was underpowered.

There were a total of 292 adverse events across all groups, however, only four were “probably” or “definitely” secondary to the products used. Forty-six serious adverse events, including death, occurred. Again, none were linked to the study products.

Some 85%, 88%, and 50% of nicotine e-cigarette users, placebo e-cigarette users, and nicotine patch users, respectively, reported that they would recommend their product to someone who wanted to quit smoking (Bullen C et al, Lancet 2013;382(9905):1629–1637).

CATR’s Take: E-cigarettes are currently a hot item, especially in states that heavily tax tobacco and prohibit smoking in public spaces. This study, the largest and most rigorous to date, was unable to reach any firm conclusions about their efficacy as aids to smoking cessation. The device and nicotine solution used in this particular trial had a favorable short-term safety profile, which is somewhat reassuring. We will need to continue to plead ignorance to our patients until better data emerge.

Research Updates: Addiction Treatment Models and E-Cigarettes

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The Carlat Addiction Treatment Report
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This article was published in print 1 & 2/2014 in 2:1.


The Carlat Psychiatry Report

 

APA Reference
Psychiatry Report, T. (2015). Research Updates: Addiction Treatment Models and E-Cigarettes. Psych Central. Retrieved on December 10, 2018, from https://pro.psychcentral.com/research-updates-addiction-treatment-models-and-e-cigarettes/

 

Scientifically Reviewed
Last updated: 2 May 2015
Last reviewed: By John M. Grohol, Psy.D. on 2 May 2015
Published on PsychCentral.com. All rights reserved.