Background In the implementation of placement matching guidelines, feasibility has been concerned in previous research. Objectives of this process evaluation were to investigate whether the patient-centered matching guidelines (PCPM) are consistently applied in referral decision-making from an inpatient qualified withdrawal program to a level of care in aftercare, which factors affect whether patients actually receive matched aftercare according to PCPM, and whether its use is feasible and accepted by clinic staff. Methods The study was conducted as process evaluation within an exploratory randomized controlled trial in four German psychiatric clinics offering a 7-to-21 day qualified withdrawal program for patients suffering from alcohol dependence, and with measurements taken during detoxification treatment and six months after the initial assessment. PCPM were used with patients in the intervention group by feeding back to them a recommendation for a level of care in aftercare that had been calculated from Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff on the treatment unit. As measurements, The MATE, the Client Socio-Demographic and Service Receipt Inventory—European Version, a documentation form, the Control Preference Scale, and the Motivation for Treatment Scale were administered. A workshop for the staff at the participating trial sites was conducted after data collection was finished. Results Among 250 patients participating in the study, 165 were interviewed at follow-up, and 125 had received aftercare. Although consistency in the application of PCPM was moderate to substantial within the qualified withdrawal program (Cohen’s kappa ≥ .41), it was fair from discharge to follow-up. In multifactorial multinomial regression, the number of foregoing substance abuse treatments predicted whether patients received more likely undermatched (Odds Ratio=1.27; p =.018) or overmatched (Odds Ratio=0.78; p =.054) treatment. While the implementation process during the study was evaluated critically by the staff, they stated a potential of quality assurance, more transparency and patient-centeredness in the use of PCPM. Conclusions While the use of PCPM has the potential to enhance the quality of referral decision making within treatment, it may not be sufficient to determine referral decisions for aftercare. Trial Registration German Clinical Trials Register DRKS00005035 . Registered 03/06/2013.

Background: Placement matching guidelines are promising means to optimize patient-centered care and to match patients’ treatment needs. Despite considerable research regarding placement matching approaches to optimize alcohol abuse treatment, findings are inconclusive. Objectives: To investigate whether the use of patient-centered placement matching (PCPM) guidelines is more effective in reducing heavy drinking and costs 6 months after discharge from an inpatient alcohol withdrawal treatment compared to usual referral to aftercare. Secondary aims were to investigate whether age, gender, trial site or level of care (LOC) are moderators of efficacy and whether patients who were actually referred to the recommended LOC had better treatment outcomes compared to patients who were treated under- or overmatched. Methods: Design. Exploratory randomized controlled trial with measurements during withdrawal treatment and 6 months after initial assessment. Setting. Four German psychiatric clinics offering a 7–21 day inpatient qualified withdrawal program for patients suffering from alcohol dependence. Participants. From 1,927 patients who had a primary diagnosis of alcohol dependence and did not have organized aftercare when entering withdrawal treatment, 299 were invited to participate. Of those, 250 were randomized to the intervention group (IG, n = 123) or the control group (CG, n = 127). Intervention. The PCPM were applied to patients of the IG by feeding back a recommendation to a LOC for aftercare that was calculated from the Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff of the treatment unit. Patients of the CG received a general feedback regarding their MATE interview on request. Measurements. The MATE, the Client Socio-Demographic and Service Receipt Inventory-­European Version and the MATE-Outcomes were administered. Data were analyzed using generalized linear models. Results: In the intention-to-treat analysis, there were no significant differences between IG and CG regarding days of heavy drinking (incident risk ratio [IRR] 1.09; p = 0.640), direct (IRR 1.06; p = 0.779), indirect (IRR 0.77; p = 0.392) and total costs (IRR 0.89; p = 0.496). Furthermore, none of the investigated moderator variables affected statistically significant drinking or cost-related primary outcomes. Regardless of group allocation, patients who received matched aftercare reported significantly fewer days of heavy drinking than undermatched patients (IRR 2.09; p = 0.004). For patients who were overmatched, direct costs were significantly higher (IRR 1.79; p = 0.024), but with no additional effects on alcohol consumption compared to matched patients. Conclusions: While the use of PCPM failed to affect the actual referral to aftercare, our findings suggest that treating patients on the recommended LOC may have the potential to reduce days of heavy drinking compared to undertreatment and costs compared to overtreatment.

The aims of this study were to preliminary examine the feasibility of existing placement matching guidelines from the Netherlands in the German health-care system and to pilot study procedures for a following randomized controlled trial (RCT). The study was conducted at a psychiatric clinic offering a 3-week alcohol withdrawal program. After intake, patients were assessed with the Measurements in the Addictions for Triage and Evaluation (MATE). At discharge, therapists made recommendations for referrals to further treatment. Six months after discharge, patients were interviewed by phone regarding alcohol consumption, health status, and health-care utilization. For the 54 participating patients, placement matching to one of the four levels of care (LOC) was calculated based on the MATE. Most patients were assigned to LOC2 or LOC3 (n = 44), whereas there was no significant association to the recommendations made by therapists. Among the 31 patients reached for follow-up, 3 did not receive treatment, 3 received treatment less, 9 more, and 13 exactly as intensive as predicted by the matching guidelines. The placement matching guidelines can be feasible.

Background Despite considerable research on substance-abuse placement matching, evidence is still inconclusive. The aims of this exploratory trial are to evaluate (a) the effects of following matching guidelines on health-care costs and heavy drinking, and (b) factors affecting the implementation of matching guidelines in the treatment of alcohol-dependent patients. Methods A total of 286 alcohol-dependent patients entering one of four participating detoxification units and having no arrangements for further treatment will be recruited. During the first week of treatment, all patients will be administered Measurements in the Addictions for Triage and Evaluation (MATE), European Quality of Life-Five Dimensions health status questionnaire (EQ-5D), and the Client Socio-Demographic and Service Receipt Inventory—European Version (CSSRI-EU). Patients who are randomly allocated to the intervention group will receive feedback regarding their assessment results, including clear recommendations for subsequent treatment. Patients of the control group will receive treatment as usual and, if requested, global feedback regarding their assessment results, but no recommendations for subsequent treatment. At discharge, treatment outcome and referral decisions will be recorded. Six months after discharge, patients will be administered MATE-Outcome, EQ-5D, and CSSRI-EU during a telephone interview. Discussion This trial will provide evidence on the effects and costs of using placement-matching guidelines based on a standardized assessment with structured feedback in the treatment of alcohol-dependent patients. A process evaluation will be conducted to facilitate better understanding of the relationship between the use of guidelines, outcomes, and potential mediating variables. Trial registration German Clinical Trials Register DRKS00005035 . Registered 03 June 2013.

Aim of the study: In the Netherlands, guidelines for the allocation of patients with alcohol related disorders to different levels of care have been implemented and evaluated nationwide. These guidelines cannot be used in the German health care system without adaptation, but with modifications they may prove useful. Aim of this study was therefore to develop an adaptation of those allocation guidelines to the German system.Methods: Using the Delphi-technique, experts in substance use treatment discussed existing addiction treatment services and indication criteria relevant for allocation in 3 rounds. The results of this process were integrated by means of a concluding consensus conference.Results: The Dutch allocation guideline was adapted for treatment decisions following detoxification treatment of alcohol dependent patients.Conclusions: The consented guideline can support the allocation of patients with alcohol-related disorders. The guideline is currently evaluated in a randomized controlled trial.

BACKGROUND Goal of the presented study is to evaluate whether alcohol-dependent patients given additional individual psychotherapy after a heavy relapse during pharmacotherapy remain abstinent for longer than those who continue with pharmacotherapy alone. METHODS In a randomized, multicenter study, 109 alcohol-dependent patients who had suffered a heavy relapse either while receiving anticraving medication or placebo were randomized into 2 groups. One group received medication, medical management, and additional individual, disorder-specific, cognitive-behavioral psychotherapy, while the control group received medication and medical management only. Main outcome was defined as days until first heavy relapse. RESULTS Fifty-four patients were randomized to the psychotherapy group, 55 to the control group. Intention-to-treat and completer analyses found no differences between groups, whereas as-treated analyses (patients who actually received psychotherapy compared with those who did not) found a significant effect of psychotherapy. CONCLUSIONS Our data indicate that patients that are willing to attend psychotherapy benefit from receiving psychotherapy in addition to pharmacotherapy. We suggest that it may be beneficial to consider patients' preferences concerning psychotherapy at an earlier stage during treatment.

Objectives Finding predictors for predrinking and placing the new phenomenon of predrinking on a greater database. Predrinking is defined as alcohol consumption, alone or with friends, at home or at public places, before going out in the evening to a party or in bars or discotheques. Methods Data were collected from a representative sample of 757 ninth- and tenth-grade students from 31 high schools located in a south German rural region and a city. Results Predrinkers, especially those who show this behaviour frequently, were notably more likely to engage in hazardous drinking, and experienced significantly more frequent involvements in fights and alcohol-induced blackouts. They also stated more often that they had the intention of getting drunk when consuming alcohol. Conclusions Predrinking proves to be a high-risk behaviour, particularly when it occurs at a high frequency. This behaviour has to be seen as part of a new youth culture, which does not seem to be limited to a certain subgroup—with all of the associated risks.