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Change in DSM‐5 Alcohol Use Disorder Criteria Count and Severity Level as a Treatment Outcome Indicator: Results from a Randomized Trial
Author(s) -
Kiluk Brian D.,
Frankforter Tami L.,
Cusumano Michelle,
Nich Charla,
Carroll Kathleen M.
Publication year - 2018
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/acer.13807
Subject(s) - alcohol use disorder , randomized controlled trial , medicine , cognitive behavioral therapy , poisson regression , clinical trial , alcohol dependence , psychiatry , alcohol , population , biochemistry , chemistry , environmental health
Background Most clinical trials evaluating treatments for alcohol use target individuals meeting diagnostic criteria for alcohol use disorder ( AUD ), but few address change in diagnostic status following treatment or as a potential outcome indicator. This study evaluated whether DSM ‐5 AUD total criteria count or severity category was sensitive to change over time and treatment effects. Methods Data were drawn from a randomized clinical trial that evaluated the efficacy of computer‐based cognitive behavioral therapy program ( CBT 4 CBT ) for AUD . Sixty‐eight individuals were randomized to 1 of the 3 weekly outpatient treatments for an 8‐week period: (i) treatment as usual ( TAU ), (ii) TAU + CBT 4 CBT , and (iii) CBT 4 CBT +brief monitoring. Structured clinical interviews were used to determine current (past 30 days) AUD diagnosis at baseline, end‐of‐treatment, and 6 months following end‐of‐treatment. Change in the total number of DSM criteria endorsed, as well as severity categories (mild, moderate, severe), was evaluated across time and by treatment condition. Results Generalized Poisson's linear mixed models revealed a significant reduction in the number of DSM criteria from baseline to treatment end point [time effect χ 2 (1) = 35.54, p < 0.01], but no significant interactions between time and treatment condition. Fewer total criteria endorsed, as well as achieving at least a 2‐level reduction in AUD severity category at end‐of‐treatment, were associated with better outcomes during follow‐up. Chi‐square results indicated a greater proportion of individuals assigned to TAU + CBT 4 CBT had at least a 2‐level reduction in severity category compared to TAU , at trend‐level significance [ χ 2 (2, 54) = 5.13, p = 0.07], consistent with primary alcohol use outcomes in the main trial. Conclusions This is the first study to demonstrate change in DSM ‐5 AUD total criteria count, as well as severity category, in a randomized clinical trial. These findings offer support for their use as a potential clinically meaningful outcome indicator.