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.
OBJECTIVE
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.
Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Freiburg Germany. michael.berner@uniklinik-freiburg.de
M
M
Berner
C
C
Günzler
K
K
Frick
L
L
Kriston
B
B
Loessl
R
R
Brück
H
H
Gann
A
A
Batra
K
K
Mann
D000427:Alcohol Deterrents / Q000627:therapeutic use*; D000437:Alcoholism / Q000188:drug therapy / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D010919:Placebos; D016032:Randomized Controlled Trials as Topic; D012931:Social Environment
D000427:Alcohol Deterrents; D010919:Placebos