Trial reportAddiction (Abingdon, England)2014
What happens when people discontinue taking medications? Lessons from COMBINE.
Trial report in Addiction (Abingdon, England), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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The trial behind it
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Who cites it
4 citing papers in PubMed.
- Combination of Drugs in the Treatment of Alcohol Use Disorder: A Meta-Analysis and Meta-Regression Study.Brain sciences · 2025Review
- Monitoring and Improving Naltrexone Adherence in Patients with Substance Use Disorder.Patient preference and adherence · 2021Review
- Recommendations for the Design and Analysis of Treatment Trials for Alcohol Use Disorders.Alcoholism, clinical and experimental research · 2015Review
- Guidelines for the Reporting of Treatment Trials for Alcohol Use Disorders.Alcoholism, clinical and experimental research · 2015Review
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
aimsWe use intensive longitudinal data methods to illuminate processes affecting patients' drinking in relation to the discontinuation of medications within an alcohol treatment study. Although previous work has focused on broad measures of medication adherence, we focus on dynamic changes in drinking both before and after patients discontinue.
designWe conducted secondary data analyses using the COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) study, focused on participants who discontinued medications prior to the planned end of treatment. Using an interrupted time-series analysis, we analysed drinking in the weeks before and after discontinuation and also studied outcomes at the end of the COMBINE follow-up.
settingUnites States of America.
participantsWe describe the subsample of COMBINE participants who discontinued medications (n = 450), and compare them with those who were medication-adherent (n = 559) and with those who discontinued but had substantial missing data (n = 217). MEASUREMENTS: The primary outcomes were percentage of days abstinent (PDA) and percentage of heavy drinking days (PHDD). Medication adherence data were used to approximate the date of discontinuation.
findingsFor many patients, an increase in drinking began weeks before discontinuation (PDA: F(1,4803) = 19.07, P < 0.001; PHDD: F(1,4804) = 8.58, P = 0.003) then escalated at discontinuation (PDA: F(1,446) = 5.05, P = 0.025; PHDD: F(1,446) = 4.52, P = 0.034). Among other effects, the amount of change was moderated by the reason for discontinuation (e.g. adverse event; PDA: F(2,4803) = 3.85, P = 0.021; PHDD: F(2,4804) = 5.36, P = 0.005) and also whether it occurred in the first or second half of treatment (PDA: F(1,4803) = 5.23, P = 0.022; PHDD: F(1,4804) = 8.79, P = 0.003).
conclusionsA patient's decision to stop taking medications during alcohol treatment appears to take place during a weeks-long process of disengagement from treatment. Patients who discontinue medications early in treatment or without medical consultation appear to drink more frequently and more heavily.
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