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Clinical Outcomes of the First 2 Years of Implementation of the Integrated Care Pathway for Concurrent Major Depressive Disorder and Alcohol Use Disorder

Published online by Cambridge University Press:  23 March 2020

A.V. Samokhvalov
Affiliation:
Centre for Addiction and Mental Health, Institute for Mental Health Policy Research/Addiction Medicine Service, Toronto, Canada
S. Awan
Affiliation:
Centre for Addiction and Mental Health, Integrated Care Pathways Program, Toronto, Canada
B. Le Foll
Affiliation:
Centre for Addiction and Mental Health, Addiction Medicine Service, Toronto, Canada
C. Probst
Affiliation:
Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
P. Voore
Affiliation:
Centre for Addiction and Mental Health, Ambulatory Care and Structured Treatments, Toronto, Canada
J. Rehm
Affiliation:
Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada

Abstract

Background

Both major depressive disorder (MDD) and alcohol use disorder are highly prevalent, often comorbid and cause significant socioeconomic burden. At CAMH, we have developed and integrated care pathway (ICP) to treat these disorders and evaluated its effectiveness in comparison to treatment as usual (TAU)

Methods

Chart review; descriptive statistics, c2 and t-tests, linear mixed effects models, Kaplan–Meier and log-rank analyses.

Results

Overall, 81 patients were enrolled into ICP. Comparisons of treatment retention rates between ICP patients and matched historical controls (n = 81) showed significantly lower dropout rate in ICP cohort (18.5% vs. 69.1%, P < 0.001, Fig. 1). The ICP patients demonstrated significant reduction in depressive symptoms severity (QIDS: 14.6 vs. 10.0, P < 0.001; BDI 26.3 vs. 16.2, P < 0.001), reduction in the amount of alcohol consumed weekly from 44.6 standard drinks at baseline to 12.6 (P < 0.001) by the end of treatment, which was significantly better compared to controls (56.9 vs. 25.2, P < 0.001), P = 0.014 (Fig. 2).

Conclusions

The ICP is a feasible approach to treatment of concurrent AUD and MDD with significantly higher retention rates than TAU. Patients demonstrate improvements on several levels including depressive symptoms, and changes in alcohol drinking patterns.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
Oral communications: Classification of mental disorders; comorbidity/dual pathologies; psychopathology; psychopharmacology and pharmacoeconomics and sleep disorders & stress
Copyright
Copyright © European Psychiatric Association 2017

Fig. 1

Fig. 2
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