ADAM: The effectiveness of adjunctive Medication Management and Contingency Management to enhance adherence to medications for relapse prevention in alcohol dependence

Project Description

Alcohol dependence causes considerable physical and mental health problems; the UK has
experienced a consistent annual increase in alcohol related hospital admissions, including for
alcoholic liver disease. Alcohol costs the UK economy an estimated £21bn per annum, of which the
NHS costs are £3.5bn. Providing effective treatment for alcohol dependence and reducing alcohol
related hospital admissions has been emphasised as a priority for the UK Government’s Alcohol
Strategy.
Approximately 4% of the adult population in the UK are affected by alcohol dependence. Currently the
main treatment interventions are talking therapies, which are highly effective in people drinking at
levels just above the guidelines for ‘safe’ drinking but are less effective in alcohol dependence and
relapse is extremely common at around 70% over 12 months post detoxification.
The effectiveness of medications in combination with talking therapies for the reduction of alcohol use
and relapse in those who are dependent is now well documented. Acamprosate (AC) is
recommended as a first line treatment by NICE. AC is thought to stabilise the imbalance between
inhibitory (GABA) and excitatory (glutamate) neurotransmitters in the brain. Despite AC’s therapeutic
potential, adherence to this medication is low and therefore the maximum benefit that could be gained
from taking it is not reached in all patients.
Medication management (MM) is an intervention to help improve medication and treatment adherence
by providing education, support and advice to service users about their drinking behaviours and
medication. This has been used in several clinical trials but is not consistently delivered as part of
routine care in specialist alcohol service in the UK.
Contingency management (CM), which involves providing small financial or other incentives to
change behaviour and/or engage with treatment, including medication adherence, has been found to
be effective in substance misusers but there is currently limited evidence available for alcohol
dependence.
The current study will investigate the effectiveness and cost-effectiveness of MM with or without CM,
compared to standard support, for increasing adherence to AC and the subsequent benefits that this
will have for alcohol consumption and associated problems.
If effective, we believe that MM with CM in addition to standard support has the potential for
application across the NHS. Reductions in alcohol consumption, relapse and the associated problems
will lessen the burden on the UK economy and the NHS. Our research group has extensive
experience in conducting research in the addictions field including the management and treatment of
alcohol dependence and the application of CM in addictions.
Along with other partners (Universities Kent, Southampton, Durham, Imperial College London and Kings College London, Humber NHS Foundation Trust and South London & Maudsley NHS Foundation Trust) the total value of the ADAM study is £2,292,369.31