Till Örebro universitet

There is a knowledge gap about predictors of treatment outcomes in alcohol use disorder (AUD) in socially stable women. This study examined factors that may predict abstinence 12 months after the end of treatment for AUD in socially stable women. Fifty-seven women with AUD participated in 12-month follow-up. Information about sociodemographic, alcohol-related, psychiatric symptoms, psychological functioning, and participants' treatment goals and ability to change alcohol habits were gathered from structured interviews and self-report instruments. Predictors for abstinence at the 12-month follow up were calculated by univariable and multivariable logistic regression models. Significant predictors for abstinence were having no history of childhood abuse (OR: 8.13; 95%CI: 2.22-29.75; p < .01) and a goal of abstinence at the end of treatment (OR: 15.17; 95%CI: 3.45-66.69; p < .001). Most participants (>60%) achieved their goals of abstinence or low-risk drinking. The results highlight the significance of identifying patients with experiences of childhood abuse, since such experiences may adversely affect the outcome of AUD treatment. Our findings also emphasize the importance of patients' own goals of abstinence, since it resulted in the most stable outcome. Treatment could, therefore, also focus on motivating individuals to aim for abstinence.

Socially stable women with alcohol use disorder (AUD) are seldom studied separately and are often marginalized in treatment of substance abuse. The overall aim of this thesis was to examine variables of importance in relation to age at onset of AUD and treatment outcome.

Study I, which included 338 men and women being treated for AUD, showed that women had a significantly later onset and shorter duration in excessive alcohol use as well as less weekly pure alcohol intake than men. Participants with earlier onset of excessive alcohol use reported significantly more psychiatric symptoms and more immature personality traits than those with later onset. 

Study II-IV included 75 women with AUD receiving outpatient treatment. Of the participants, 68% reported a history of childhood maltreatment. Emotional abuse and their mother’s alcohol and/or substance problems were independent predictors of earlier age at onset of AUD. In Study III treatment outcome was measured as a change in alcohol consumption. A more positive change, especially with regard to abstinence, was found in women who did not report childhood abuse. Study IV showed that, at 12month follow up, most of the participants had reached their end-oftreatment goal either abstinence or low-risk drinking. However, those with a goal of abstinence at the end of treatment showed significantly less risk drinking than those with low-risk drinking as a goal. The most important predictor of abstinence at the 12-month follow up was having abstinence as an end –of –treatment goal. 

These results indicate the importance of identifying and addressing childhood trauma in treating socially stable women with AUD. Focusing on motivational changes during treatment may also be of importance, especially in patients with relapses, as abstinence still is the most stable treatment option.

Background: To examine the relationship between treatment outcome, as measured according to change in alcohol consumption, and a history of childhood abuse (emotional, physical, sexual) in socially stable women undergoing treatment for alcohol use disorder (AUD).

Methods: Participants were assessed using the Addiction Severity Index and the Mini International Neuropsychiatric Interview at the beginning of treatment (n = 75), end of treatment (n = 59) and 12 month follow-up after treatment (n = 57). Self-report data on alcohol consumption were obtained at all three time-points using the Alcohol Habits Inventory-Revised 2. Self-report data on childhood maltreatment were obtained at the beginning of treatment using the Childhood Trauma Questionnaire-short form. Study outcomes were changes in alcohol consumption (grams of pure alcohol per week), risk-drinking and reported abstinence.

Results: Of the 75 women enrolled, 38 (50.7%) reported a history of childhood abuse and the rest did not. Both groups showed a significant improvement in all three outcomes at the end of treatment and at 12-month follow-up. At the end of treatment, a significant inter-group difference was found for reported abstinence (non-abused group, 39.3% vs abused, 12.9%; p < 0.05). At 12-month follow-up, significant inter-group differences were observed for all treatment outcomes, with superior outcomes being found for the non-abused group, including a higher proportion of women with reported abstinence (55.6% vs 13.3%; p < 0.01).

Conclusion: The present findings suggest that an evaluation of a possible history of childhood abuse is warranted in all women seeking treatment for AUD, irrespective of social stability. In terms of clinical practice, the results suggest that additional interventions may be warranted in this population.

It is unclear whether exposure to childhood maltreatment is associated with the age of onset of alcohol use disorder (AUD). A group of socially stable women with AUD seeking treatment (n = 75) were interviewed using the Addiction Severity Index and the Mini International Neuropsychiatric Interview. They also filled out the Childhood Trauma Questionnaire-short form. Emotional abuse, sexual abuse and multiple childhood traumas were found to be associated with earlier onset of AUD. Multivariable linear regression analysis showed that independent predictors for an earlier onset of AUD were exposure to emotional abuse (beta = -7.44, SE = 2.83, adjusted p = 0.010) and mother's alcohol/substance problems (beta = -7.87, SE = 3.45, adjusted p = 0.026). These variables explained 18.9% of the variance of age of onset of AUD. These findings highlight a need for increased clinical attention to AUD subgroups who have experienced childhood maltreatment, especially emotional abuse, as well as a need for including support in the patient's own parental role in the treatment.

Psychiatric symptoms and personality characteristics were studied in men (n=252) and women (n=86) as they commenced treatment for excessive alcohol use. The Addiction Severity Index, Symptom Check List, and Temperament and Character Inventory were used. ANOVA with early/late onset and gender as covariates showed significantly lower scores for psychiatric symptoms and more mature personality characteristics in the late-onset group compared to early onset. Men described more depression and anxiety, and women higher persistence. Results indicate the importance of considering age at onset of excessive alcohol use when patients enter treatment because different treatment approaches may be required.