Treatment retention and reductions in blood alcohol concentration (BAC) during the first 90 days of a telehealth program for alcohol use disorder

Figures & data

Table 1. Patient demographics and clinical services received in the first 90 days of treatment program.

		Patients with 90-day treatment retention (N = 2066)		Patients without 90-day treatment retention (N = 2055)
Categorical measures		N	(%)	N	(%)	p-value
Gender	Woman	1078	(52.2%)	1043	(50.8%)	<0.001
	Man	987	(47.8%)	823	(40.0%)
	Another gender	0	(0.0%)	3	(0.1%)
	Unknown	1	(0.0%)	186	(9.1%)
Drinking goal	Abstinence	401	(19.4%)	368	(17.9%)	<0.001
	Controlled drinking	1334	(64.6%)	1004	(48.9%)
	Unknown	331	(16.0%)	683	(33.2%)
Medication orders (1 or more)	Acamprosate	193	(9.3%)	142	(6.9%)	0.004
	Acetylcysteine	4	(0.2%)	0	(0.0%)	0.12
	Baclofen	77	(3.7%)	46	(2.2%)	0.01
	Gabapentin	966	(46.8%)	661	(32.2%)	<0.001
	Naltrexone	1855	(89.8%)	1273	(61.9%)	<0.001
	Ondansetron	9	(0.4%)	8	(0.4%)	>0.99
	Thiamine	1219	(59.0%)	929	(45.2%)	<0.001
	Topiramate	73	(3.5%)	50	(2.4%)	0.04
	Any medication	2027	(98.1%)	1470	(71.5%)	<0.001
Encounters (1 or more)	Medical	2054	(99.4%)	1518	(73.9%)	<0.001
	Coaching	2022	(97.9%)	1528	(74.4%)	<0.001
Continuous measures		M	(SD)	M	(SD)	p-value
Age		49.46	(11.01)	46.81	(10.83)	<0.001
Unique medications ordered (1–8)		2.13	(0.89)	1.51	(1.19)	<0.001
Medical encounters (days 1–90)		3.80	(1.46)	2.02	(1.64)	<0.001
Coaching encounters (days 1–90)		10.41	(4.15)	5.07	(4.47)	<0.001
BACs (days 1–90)		89.48	(52.57)	32.37	(34.51)	<0.001
Days with a BAC (days 1–90)		54.45	(25.42)	25.80	(19.08)	<0.001

“Unique medications ordered” reflects the number of different medications prescribed to a patient; for example, a patient who is prescribed both naltrexone and thiamine would have 2 unique medications ordered. P-values were computed using Fisher’s exact test for categorical measures and using independent samples t-tests for continuous measures, and compare patients with versus without 90-day treatment retention. BAC = blood alcohol concentration.

Figure 1. Trajectory of daily estimated peak BAC among patients with 90-day treatment retention.

Model-implied trajectories are displayed as lines; observed means for daily estimated peak blood alcohol concentration (BAC) are displayed as circles. Trajectory analyses identified significant reductions in daily estimated peak BAC from days 1-14 (p < 0.001) and days 15-90 (p < 0.001). Analyses are based on 112,464 daily BAC estimates provided by 2066 patients.

Table 2. Growth curve model results showing significant reductions in daily estimated peak BAC over the 90 day observation period.

	Coefficient	(SE)	p-value
Fixed effects
Intercept (mean BAC at day 14)	0.057	(0.001)	<0.001
Earlier change (days 1–14)	−0.076	(0.003)	<0.001
Later change (days 15–90)	−0.007	(0.000)	<0.001
Random effects	SD
Intercept	0.045
Early treatment change	0.097
Later treatment change	0.014
Residual	0.056

Earlier change and later change parameters were coded such that fixed effect coefficients represent the expected amount of change in estimated peak BAC over a 28-day period. The model intercept was centered such that the intercept coefficient reflects the estimated peak BAC on day 14. BAC = blood alcohol concentration. Analyses are based on 112,464 daily estimated peak BAC values provided by 2066 patients with 90-day treatment retention.

Figure 2. Trajectories of daily estimated peak BAC by gender among patients with 90-day treatment retention.

Model-implied trajectories are displayed as lines; observed means for daily estimated peak blood alcohol concentration (BAC) are displayed as circles and triangles. Trajectory analyses indicated that reductions in daily estimated peak BAC were not significantly moderated by gender during days 1-14 (p = 0.079) or days 15-90 (p = 0.077). Analyses are based on 112,403 daily BAC estimates provided by 2065 patients.

Figure 3. Trajectories of daily estimated peak BAC by treatment goal among patients with 90-day treatment retention.

Note: Model-implied trajectories are displayed as lines; observed means for daily estimated peak blood alcohol concentration (BAC) are displayed as diamonds, exes, and circles. Trajectory analyses indicated that reductions in daily estimated peak BAC were not moderated by treatment goal during days 1-14 (p = 0.166 and 0.132 for controlled drinking goal and unknown drinking goal versus abstinence goal, respectively) or during days 15-90 (p = 0.925 and 0.765 for controlled drinking goal and unknown drinking goal versus abstinence goal, respectively). Analyses are based on 112,464 daily BAC estimates provided by 2066 patients.

Table 3. Growth curve model results showing that changes in BAC were not significantly moderated by gender.

	Coefficient	(SE)	p-value
Fixed effects
Intercept	0.058	(0.001)	<0.001
Early treatment change (days 1–14)	−0.080	(0.004)	<0.001
Male gender	−0.003	(0.002)	0.111
Later treatment change (days 15–90)	−0.008	(0.001)	<0.001
Early treatment change × Male gender	0.009	(0.005)	0.079
Later treatment change × Male gender	0.001	(0.001)	0.077
Random effects	SD
Intercept	0.045
Early treatment change (days 1–14)	0.097
Later treatment change (days 15–90)	0.014
Residual	0.056

Female was the reference value for the gender measure. Analyses are based on 112,403 daily estimated peak BAC values provided by 2065 patients with 90-day treatment retention.

Table 4. Growth curve model results showing that changes in BAC were not significantly moderated by drinking goal.

	Coefficient	(SE)	p-value
Fixed effects
Intercept	0.044	(0.002)	<0.001
Early treatment change (days 1–14)	−0.067	(0.006)	<0.001
Controlled drinking goal	0.018	(0.003)	<0.001
Other or unknown drinking goal	0.010	(0.004)	0.006
Later treatment change (days 15–90)	−0.007	(0.001)	<0.001
Early treatment change × Controlled drinking goal	−0.010	(0.007)	0.166
Early treatment change × Unknown drinking goal	−0.014	(0.009)	0.132
Later treatment change × Controlled drinking goal	0.000	(0.001)	0.925
Later treatment change × Unknown drinking goal	0.000	(0.001)	0.765
Random effects	SD
Intercept	0.044
Early treatment change (days 1–14)	0.096
Later treatment change (days 15–90)	0.014
Residual	0.056

Abstinence drinking goal was the reference value for the drinking goal measure. Analyses are based on 112,464 daily estimated peak BAC values provided by 2066 patients with 90-day treatment retention.