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. 2008 Jun 10;17(Suppl 1):S60–S64. doi: 10.1002/mpr.250

Finding the ideal place for a psychotherapeutic intervention in a stepped care approach – a brief overview of the literature and preliminary results from the Project PREDICT

M Berner 1,✉, C Günzler 1, K Frick 1, L Kriston 1, B Loessl 1, R Brück 1, H Gann 1, A Batra 2, K Mann 3
PMCID: PMC6879086  PMID: 18543364

Abstract

Aims: To provide an overview over empirical evidence regarding stepped care approaches that include psychotherapies. To present own preliminary study results in alcohol dependent patients.

Methods: Publications were searched in the databases Medline, PsycINFO and the internet search engine Google Scholar. Inclusion criteria were psychosocial treatment and psychiatric disorders. Our own study consists of two steps. In step 1 patients receive anti‐craving medication or placebo and Medical Management (MM). After a relapse to heavy drinking patients can step up and after randomization they either continue with the same treatment or they receive additional alcoholism specific psychotherapy (ASP).

Results: Evidence suggests that stepped care might be efficacious in patients with obsessive‐compulsive behavior and depression. There is no evidence for efficacy in problem drinkers. Results of our own study show that the completer rate in MM alone is higher than in ASP with MM, but there are no significant differences concerning age, sex and disease severity between completer and non‐completer in both study arms.

Conclusions: Further research with regard to stepped care in alcohol dependent patients is needed. An introduction of the psychotherapy at earlier stages might be sensible. Copyright © 2008 John Wiley & Sons, Ltd.

Keywords: psychotherapeutic intervention, stepped care approach, alcoholism

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REFERENCES

  1. Anton RF, O'Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, Gastfriend DR, Hosking JD, Johnson BA, LoCastro JS, Longabaugh R, Mason BJ, Mattson ME, Miller WR, Pettinati HM, Randall CL, Swift R, Weiss RD, Williams LD. Zweben A and COMBINE Study Research Group. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA 2006; 295: 2003–17. [DOI] [PubMed] [Google Scholar]
  2. Araya R, Rojas G, Fritsch R, Gaete J, Rojas M, Simon G, Peters TJ. Treating depression in primary care in low‐income women in Santiago, Chile: a randomised controlled trial. Lancet 2003; 361: 995–1000. DOI: 10.1016/S0140‐6736(03)12825–5 [DOI] [PubMed] [Google Scholar]
  3. Bien TH, Miller WR, Tonigan JS. Brief interventions for alcohol problems: a review. Addiction 1993; 88: 315–35. [DOI] [PubMed] [Google Scholar]
  4. Breslin FC, Sobell MB, Sobell LC, Buchan G, Cunningham JA. Toward a stepped care approach to treating problem drinkers: the predictive utility of within‐treatment variables and therapist prognostic ratings. Addiction 1997; 92: 1479–89. [PubMed] [Google Scholar]
  5. Breslin FC, Sobell MB, Sobell LC, Cunningham JA, Sdao‐Jarvie K, Borsoi D. Problem drinkers: evaluation of a stepped‐care approach. J Subst Abuse 1998; 10: 217–32. DOI: 10.1016/S0899‐3289(99)00008‐5 [DOI] [PubMed] [Google Scholar]
  6. Haaga DAF. Introduction to the special section on stepped care models in psychotherapy. J Consult Clin Psychol 2000; 68: 547–8. DOI: 10.1037/0022‐006X.68.4.547 [PubMed] [Google Scholar]
  7. Lin EH, VonKorff M, Russo J, Katon W, Simon GE, Unutzer J, Bush T, Walker E, Ludman E. Can depression treatment in primary care reduce disability? A stepped care approach. Arch Fam Med 2000; 9: 1052–8. [DOI] [PubMed] [Google Scholar]
  8. Mann K, Goodman A, Kiefer F, Lehert P, Mason B, Smolka MN, Spanagel R, Zimmermann U, Littleton JM. Differential treatment effects of acamprosate: who might benefit? Alcohol Clin Exp Res, in press. [Google Scholar]
  9. Miller WR, Moyers TB, Arciniega L, Ernst D, Forcehimes A. Training, supervision and quality monitoring of the COMBINE Study behavioral interventions. J Stud Alcohol 2005; Suppl. 15: 188–95. [DOI] [PubMed] [Google Scholar]
  10. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta‐analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta‐analyses. Lancet 1999; 354: 1896–900. [DOI] [PubMed] [Google Scholar]
  11. Newman MG. Recommendations for a cost‐offset model of psychotherapy allocation using generalized anxiety disorder as an example. J Consult Clin Psychol 2000; 68: 549–55. DOI: 10.1037/0022‐006X.68.4.549 [PubMed] [Google Scholar]
  12. Otto MW, Pollack MH, Maki KM. Empirically supported treatments for panic disorder: costs, benefits, and stepped care. J Consult Clin Psychol 2000; 68: 556–63. DOI: 10.1037/0022‐006X.68.4.556 [PubMed] [Google Scholar]
  13. Sculpher M, Millson D, Meddis D, Poole L. Cost‐effectiveness analysis of stratified versus stepped care strategies for acute treatment of migraine: the Disability in Strategies for Care (DISC) Study. Pharmacoeconomics 2002; 20: 91–100. [DOI] [PubMed] [Google Scholar]
  14. Skinner HA, Allen BA. Alcohol dependence syndrome: measurement and validation. J Abnorm Psychol 1982; 91: 199–209. DOI: 10.1037/0021‐843X.91.3.199 [DOI] [PubMed] [Google Scholar]
  15. Sobell MB, Sobell LC. Stepped care as a heuristic approach to the treatment of alcohol problems. J Consult Clin Psychol 2000; 68: 573–9. DOI: 10.1037/0022‐006X.68.4.573 [PubMed] [Google Scholar]
  16. Tolin DF, Diefenbach GJ, Maltby N, Hannan S. Stepped care for obsessive‐compulsive disorder: a pilot study. Cogn Behav Pract 2005; 12: 403–14. [Google Scholar]
  17. Von Korff M, Moore JC. Stepped care for back pain: activating approaches for primary care. Ann Intern Med 2001; 134: 911–7. [DOI] [PubMed] [Google Scholar]
  18. Wilson GT, Vitousek KM, Loeb KL. Stepped care treatment for eating disorders. J Consult Clin Psychol 2000; 68: 564–72. DOI: 10.1037/0022‐006X.68.4.564 [PubMed] [Google Scholar]

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