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- deBejczy, Andrea, et al.
(författare)
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Varenicline for Treatment of Alcohol Dependence: A Randomized, Placebo-Controlled Trial
- 2015
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Ingår i: Alcoholism-Clinical and Experimental Research. - : Wiley. - 0145-6008 .- 1530-0277. ; 39:11, s. 2189-2199
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAlcohol dependence is a devastating illness affecting a large population, and new pharmacological treatments with good efficacy are greatly needed. One potential candidate is varenicline, a smoking cessation agent with partial agonist action at (42) nicotinic acetylcholine receptors. MethodsA total of 160 subjects, 30 to 70years of age, fulfilling DSM-IV criteria for alcohol dependence without any serious physical or mental disorders, were recruited through advertisement at 3 university clinics in Sweden during March 2009 to January 2011. After a 2-week placebo run-in period, subjects received 2mg varenicline daily (titrated from 0.5mg during first week) or placebo for 12weeks in a double-blind manner. ResultsThe primary outcome was the proportion of heavy drinking days, measured by self-reported alcohol consumption. Primary and secondary outcomes were calculated as a mean over the 10-week steady-state active treatment period. In the primary outcome analysis, no effect of varenicline over placebo was found (p=0.73 for the intention to treat [ITT] and 0.92 for per protocol [PP]). Secondary outcome analysis found a significant reduction of specific alcohol marker phosphatidylethanol (PEth) in the blood in the varenicline group compared to placebo (p=0.02 ITT). Craving (p=0.048 PP) and Alcohol Use Disorders Identification Test (AUDIT) scores (p=0.015 ITT) were also reduced in the active treatment group. PEth more strongly correlated with self-reported alcohol consumption than carbohydrate-deficient ttransferrin and -glutamyl transferase, and correlation coefficients were higher in the varenicline group than in the placebo group for all markers. ConclusionsAlthough the results of the main outcome of this study did not support an effect of varenicline in alcohol-dependent individuals, the secondary analyses of PEth, craving and AUDIT score support an effect of varenicline on alcohol consumption. The disclosure of a treatment effect and the lack of a clear placebo effect when using PEth as outcome variable, together with a nonsymmetric bias associated with self-reported data, strongly argue for using the specific biomarker PEth in studies of treatments of alcohol dependence.
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- Kallmen, H, et al.
(författare)
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Psychometric Properties of the AUDIT, AUDIT-C, CRAFFT and ASSIST-Y among Swedish Adolescents
- 2019
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Ingår i: European addiction research. - : S. Karger AG. - 1421-9891 .- 1022-6877. ; 25:2, s. 68-77
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Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background/Aims:</i></b> Not enough is known about the psychometric properties of screening instruments for problematic alcohol consumption among adolescents. The aim of the current study was to evaluate and compare the performance of the screening instruments: Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, CRAFFT, and the alcohol domain of Alcohol, Smoking and Substance Involvement Screening Test-Youth (ASSIST-Y) among adolescents and to suggest optimal cut-offs indicating problematic use. <b><i>Methods:</i></b> Data was collected from a general population sample (<i>n</i> = 1,421) and a treatment-seeking sample (<i>n</i> = 59) using electronic versions of the instruments. <b><i>Results:</i></b> The internal consistencies for the instruments were fair (alpha’s AUDIT 0.74, AUDIT-C 0.75, CRAFFT 0.67, ASSIST-Y 0.62), and test-retest reliabilities were good to excellent (intraclass correlation coefficients AUDIT 0.86, AUDIT-C 0.93, CRAFFT 0.77, ASSIST-Y 0.63). The CRAFFT and ASSIST-Y demonstrated reasonable construct validities while factor solutions for AUDIT and AUDIT-C could not be determined. The optimal cut-off score was 2 for both CRAFFT and ASSIST-Y (61 and 73% sensitivities and 79 and 65% specificities, respectively), while sensitivity scores were poor for AUDIT and AUDIT-C. <b><i>Conclusion:</i></b> Based on the current sample, ASSIST-Y and the CRAFFT performed better than AUDIT and AUDIT-C. Health-care clinics working with adolescents should carefully consider their choice of screening instruments.
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