More Oversight Does Not Lower Alcohol Abuse, Study Says

A new study suggests more intensive therapies do not increase a person's abstinence from alcohol.

A new study says chronic care management does not increase a person’s abstinence from alcohol or drugs.
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People with alcohol and other drug dependence problems who receive more intensive therapies, such as counseling, social work assistance and other education activities, are no less likely to stop abusing these substances than those who receive typical primary care, according to a study from the Boston Medical Center released Tuesday.

Richard Saitz, a professor of medicine and epidemiology at Boston University, led a study that examined the effects different treatments have on people with substance abuse and dependence problems. Saitz and his team randomly split 563 participants into two groups: one receiving usual treatment from a primary care physician (an appointment and a counseling phone number) and another receiving chronic care management (CCM), which includes treatments such as motivational enhancement therapy, relapse prevention counseling, and psychiatric treatment.

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A year later, the group found there was no significant difference in the percentage of people from either group who abstained from "opioids, stimulants, or heavy drinking." Of those who received chronic care management, 44 percent remained abstinent, compared with 42 percent of those who received typical primary care.

Several other studies have shown CCM can be successful when used in treating other medical conditions – such as diabetes and high blood pressure – as well as mental health conditions, and that it can reduce health care costs for those patients by lowering the number of emergency visits and hospitalizations.

There remains a debate regarding whether alcohol and substance addictions should be treated as diseases, as some argue these conditions stem from personal choices, rather than biological factors. But Patrick O'Connor, a professor of medicine at the Yale School of Medicine, said substance addictions, like other chronic diseases, have prolonged durations and "substantial morbidity and mortality" rates.

Due to these similarities, O'Connor writes in an editorial published in the journal JAMA, along with the study, "there is no doubt that alcohol and other drug use disorders are prototypical chronic diseases and should be approached as such by the health care system."

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Still, the authors say more research is needed to determine what the best course of action is when treating substance abuse, or if more intensive or long-term CCM might be beneficial.

"Our findings at least raise the possibility that not all chronic diseases are the same and that CCM may not have the same effect across conditions for which complexity varies, a possibility that should be part of the conversation when models of care are implemented widely," the report says. "Even though CCM is effective for a number of chronic conditions, it may be premature to assume that CCM will be the solution to improve the quality of care for and reduce costs of patients with addiction."

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