Clinical trial NCT06620276: ACT_for Alcohol Use Disorder and Depression
Official title: Acceptance and Commitment Therapy in Patients With Alcohol Use Disorder and Comorbid Treatment-Resistant Depression Who Are Undergoing Ketamine Intervention: A Feasibility Study
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Depression - Major Depressive Disorder
Alcohol Use Disorder
Keywords: Depression
Psychotherapy
Alcohol Use Disorder
Lead sponsor: Centre hospitalier de l'Université de Montréal (CHUM)
Sponsor class: OTHER
First posted: 2024-10-01
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Assessing the feasibility of providing Acceptance and Commitment Therapy (ACT) to patients diagnosed with Alcohol Use Disorder and Treatment-Resistant Depression who are undergoing ketamine sessions.
Primary purpose: OTHER

Brief summary: Alcohol use disorders (AUDs) and depressive disorders frequently coexist, complicating the clinical management of patients suffering from them.

Taken separately, these two disorders have a significant prevalence in the population, and a recent meta-analysis concluded that coexistence could reach 1 in 5 patients (20.8%). This comorbidity represents a considerable challenge, particularly in cases of treatment-resistant depression (TRD), where patients do not respond to conventional pharmacological interventions.

Since alcohol can act as a powerful trigger for depressive symptoms, and conversely, a depressive state increases the risk of alcohol abuse, the question of intervention sequence is also of clinical interest: should priority be given to treating TRD, AUD or both simultaneously? This question raises a major issue for healthcare professionals, as current conventional therapeutic approaches present limitations in the concomitant management of these complex disorders.

Thus, in certain clinical settings, ketamine has emerged as a promising intervention to treat both TRD and AUD. In fact, ketamine has been shown to produce rapid but only transient antidepressant effects, and is part of the possible treatment arsenal for TRD. The potential of ketamine in the treatment of AUD has also been explored in recent studies, with a few small randomized controlled trials. In these trials, the combination of ketamine with psychotherapy, versus placebo, was investigated as a means of alleviating AUD. Ketamine was shown to increase abstinence rates, time to relapse and decrease the number of heavy drinking days.

Acceptance and Commitment Therapy (ACT) is a form of cognitive-behavioural therapy that emphasizes psychological flexibility and acceptance of difficult emotions and thoughts without judgment, a type of psychotherapy particularly relevant to AUD. Thus, adding ACT to ketamine treatment could increase the duration of ketamine's effect on depressive symptoms, while reducing AUD.

In view of this accumulated evidence of the potential benefit of ketamine and ACT, adding acceptance and commitment therapy to ketamine appears to be a promising option for improving outcomes in patients diagnosed with TRD comorbid with AUD. This study will not only verify the feasibility of this type of intervention in this particular patient population, but also the preliminary effects on their alcohol consumption and depressive symptoms.

Detailed description: Study rationale Acceptance and Commitment Therapy (ACT) has been proposed as a particularly well-suited form of psychotherapy to be added to ketamine for improving its rapid but short antidepressant action. This is in part because of ketamine's acute effect on psychological flexibility, a crucial construct that is addressed with ACT.

There has been extensive efforts to find effective strategies to enhance and sustain the therapeutic response of ketamine, with most attempts using various pharmacotherapies-such as clonidine, D-cycloserine, lamotrigine, lithium, rapamycin, and riluzole- which have yielded mostly disappointing results. Consequently, the most common approach to extending ketamine benefits has been to administer repeated doses, although there is limited evidence supporting the long-term safety, efficacy, and practicality of this practice.

Substantial evidence indicates that psychotherapy can enhance the effects of pharmacological treatments, such as oral antidepressants, and even help maintain their benefits after discontinuation. While further research is required, it is plausible to assume that similar benefits of adding psychotherapy could extend to ketamine, particularly considering its potential neuroplastic effects.

In view of the accumulated evidence, the addition of ACT to a ketamine intervention appears as a promising option to improve the outcomes of patients diagnosed with AUD comorbid with TRD. This study will not only verify the feasibility of adding psychotherapy to ketamine in this population, but also the effect on their alcohol consumption and depressive symptoms.

Background Alcohol Use Disorder (AUD) and depressive disorders frequently coexist and complicate the clinical management and treatment outcomes for patients. It is estimated that around 1 in 10 people (10.4%) in the USA is experiencing a major depressive disorder (MDD) in the course of a year, while it goes up to 1 in 5 (20.6%) in the course of a lifetime. As for AUD, twelve month and lifetime prevalence are respectively 13.9% and 29.1%. When these disorders coexist, the prevalence is estimated as high as 20.8%, as reported by a recent meta-analysis. Research has also shown that individuals with AUD are approximately 2.3 times more likely to experience MDD within a given year.

This comorbidity presents a formidable challenge, particularly in cases of Treatment-Resistant Depression (TRD), a subset of MDD where patients do not respond to conventional pharmacological interventions. In the United States, it is estimated that out of 8.9 million adults receiving medication for MDD, 2.8 million, or 30.9%, are grappling with TRD. The economic impact is substantial, with the total annual cost of medication-treated MDD reaching $92.7 billion, nearly half of which-$43.8 billion or 47.2%-is attributable to TRD.

The concomitance of TRD and AUD represents a major clinical challenge as alcohol can act as a powerful trigger for depressive symptoms, and conversely a depressive state can increase the risk of alcohol abuse. This creates a complex, bidirectional relationship between the two disorders, considerably complicating the assessment and clinical management of these concurrent disorders. The question of intervention sequence is also of clinical interest: should treatment of TRD, AUD, or both simultaneously be prioritized? This question raises major challenges for health professionals, as current conventional therapeutic approaches present limitations in the concomitant management of these complex disorders. Traditional pharmacological treatments, such as antidepressants, may not be sufficiently effective or tolerated by some patients to treat these comorbid disorders. As for standard psychotherapeutic approaches, such as cognitive-behavioral therapy, the heterogeneity of symptoms and diversity of issues often mean that the needs of individuals suffering from these comorbidities cannot be met comprehensively.

In response to this challenge, in selected clinical settings, ketamine has emerged as a promising intervention for treating both AUD and depressive disorders. Ketamine, an NMDA receptor antagonist, has been shown to produce rapid and substantial, albeit short-lived (i.e. 7 days), antidepressant effects in individuals with TRD. Furthermore, ketamine potential in treating AUD has been explored in recent studies, with randomized controlled trials emerging. In such trials, the combination of ketamine to psychotherapy as compared to a placebo is studied to alleviate AUD. For instance, individuals with AUD who received a ketamine infusion and motivational therapy had improved rates of abstinence, prolonged time to relapse, and fewer days of heavy drinking than individuals with AUD who received an infusion of midazolam, considered as a placebo. Another team also compared the use of ketamine with a relapse prevention-based psychological therapy to placebo and found that there was a significant increase in the number of days abstinent from alcohol.

Considering the substantial but transient effect of ketamine on depressive symptomatology, and its promising results in AUD patients, a novel approach is to add a psychotherapeutic component to the ketamine treatment with the aim of enhancing and prolonging its effect. Acceptance and Commitment Therapy (ACT) seems to be a particularly well-suited form of psychotherapy to be added to ketamine treatment. Indeed, ACT is a form of cognitive-behavioural therapy that emphasizes psychological flexibility and the acceptance of difficult emotions and thoughts without judgment. ACT has been extensively studied in various psychopathologies, including anxiety and depression, demonstrating positive outcomes in multiple rigorous clinical trials and meta-analysis. Growing evidence suggest that ACT may be an effective and even superior treatment for individuals with substance use disorders ACT encourages individuals to commit to behavior changes consistent with their values, which can be particularly beneficial for those with AUD and comorbid TRD. Ketamine has been shown to have an acute effect on psychological flexibility, and the addition of ACT's focus on acceptance and value-driven behavior holds promise for improving the ketamine's rapid and short antidepressant action and addressing the complex interplay of AUD and TRD.

Standard treatment options

Alcohol Use Disorder (AUD):

In 2023, a committee of AUD specialists published the Canadian guideline with treatment recommendations for AUD. As a strong recommendation, they first proposed that all patients with AUD should be offered specialist-led psychosocial treatment interventions, such as cognitive behavioral therapy or family-based therapy. However, both therapies were found to have small to medium beneficial impacts on AUD outcomes. For pharmacotherapy, as a complement to the psychosocial treatment, naltrexone or acamprosate were recommended as first-line therapy. Second-line options, some of them being used as off-label therapies, were also proposed, namely gabapentin, topiramate and disulfiram. Of note, these recommendations are in line with other reviews of AUD pharmacotherapy and other national guidelines (namely American and Australian guidelines).

However, there are some limitations associated with the use of those treatment options. Apart from safety concerns, with common AE associated with treatments (nausea, dizziness and fatigue, among others), there is an ongoing debate among experts about the actual efficacy of the treatment options. In fact, naltrexone and acamprosate have an estimated number needed to treat to prevent a return to heavy drinking of 12, with modest differences found when comparing drugs with placebo, contributing to their underutilization in AUD patients. For instance, in over 28,000 Medicare beneficiaries hospitalized with a primary or secondary diagnosis of AUD, it was found that only 0.7% of patients started pharmacotherapy within two days after discharge and 1.3% within 30 days. Even among patients for whom AUD was the primary diagnosis after hospitalization, only 2.3% started pharmacotherapy within two days of discharge.

Treatment Resistant Depression (TRD):

Leading experts in TRD summarized in 2023 the options available to try and reach a favorable outcome in individuals who fail to respond to at least two adequate trials of psychotropics against depression. First, extending a current antidepressant trial could be a potential treatment plan. A systematic review determined that up to 20% of patients who did not respond to their antidepressant in the first four weeks of treatment responded during the following four weeks (from weeks five to eight), and up to 10% during weeks nine to twelve. Similarly, there is some evidence, albeit conflicting, that switching antidepressants or combining antidepressants could benefit some patients, especially if the change or addition involves a new mechanism of action. To cite only one example of this option, adding antidepressants with antagonism activity on the alpha-2 receptor (i.e., mirtazapine, trazodone) to a selective serotonin reuptake inhibitor was superior to monotherapy in a meta-analysis.

Other treatment modalities have also been studied, including adding various pharmacological agents like second-generation antipsychotics and mood stabilizers. In real-world settings, most patients with TRD are prescribed multiple psychotropic medications, often for extended periods, with generally limited success. For example, a recent cohort study conducted over 12 months across various European countries, involving 411 patients with TRD, highlighted high rates of polypharmacy alongside modest clinical improvement-only about 30% showed a positive response after 6 to 12 months of consistent treatment. The study also indicated a concerning level of therapeutic inertia, where 60% of patients did not undergo any changes in their treatment plan, despite ongoing poor outcomes.

Electroconvulsive therapy (ECT), aside from the usual pharmacological approaches, is considered one of the most empirically supported interventions for TRD. However, despite its effectiveness, ECT is often hindered by significant barriers, including societal stigma, inconsistent access, and notable side effects such as memory loss, largely due to the need for general anesthesia during the procedure.

Amid the current treatment challenges, the rapid and robust antidepressant effects of subanesthetic doses of IV racemic ketamine-a distinctive N-methyl-D-aspartate (NMDA) receptor antagonist-have sparked considerable interest and optimism. Meta-analyses suggest that nearly half of patients with treatment-resistant depression (TRD) experience a significant reduction in depressive symptoms (over 50%) within just hours to days following a single 40-minute IV ketamine infusion. This promising efficacy has led many experts to regard subanesthetic ketamine as one of the most transformative advancements in psychiatric pharmacology in recent decades. While impressive, ketamine's benefits typically fade within days or weeks.

Given the evidence of ketamine's beneficial effect, the neuromodulation service of the CHUM began providing this treatment to patients with TRD in 2018, covering the whole province of Quebec. Since then, the neuromodulation service has created a state-of-the-art infrastructure for the ketamine service.

Eligibility criteria: Inclusion Criteria:

Patients who satisfy the following inclusion and exclusion criteria of the study will be invited to enroll:

1. Have a diagnosis of treatment-resistant unipolar or bipolar depression (TRD) (defined as the failure to respond to at least two adequate trials of psychotropics with Level 1 evidence against bipolar or unipolar depression, according to Canadian national depression guidelines)
2. Have comorbid Alcohol Use Disorder (AUD) as diagnosed by a trained psychiatrist,
3. Have been accepted for treatment by IV ketamine for depression and AUD (Full inclusion and exclusion criteria are provided below. This includes solely clinical criteria, which will be verified by the clinical team at the CHUM neuromodulation ketamine clinic.)

Additional criteria :

* Provision of written informed consent after reading the patient information handout;
* Desire to engage in 8 weekly psychotherapy sessions;
* No changes to medications during treatment;
* Alcohol Use Disorder (AUD) as diagnosed by a trained psychiatrist, with an average daily ethanol consumption of at least a moderate risk according to the WHO risk level (Men:\&gt;40 to 60 g/day or\&gt;2.9 to 4.3 drinks/Women:\&gt;20 to 40 g/day or\&gt;1.4 to 2.9 drinks) (70, 71);
* Bipolar and unipolar depressive episode, current episode of depression (DSM-5) despite at least two adequate trials of psychotropics with Level 1 evidence against bipolar and unipolar depression (63, 64) as per the Montgomery-Asberg Depression Rating Scale (MADRS) ≥ 20 (83, 84);
* Age\&gt; 18-70 years old;
* No contraindication to ketamine
* Accept to abstain from consuming grapefruit juice (a potent 3A4 cytochrome inhibitor) on the day of the ketamine infusions as it may alter the metabolism of ketamine
* Accept to abstain from driving or operating heavy machinery

Exclusion Criteria:

Participants will be excluded if any of the following criteria are met:

* currently participating in other evidence-based psychotherapeutic intervention for mood disorders or substance abuse
* Are not able to commit to the study protocol secondary to professional/personal obligations
* Are non-English or non-French speaking.
* Other psychiatric comorbidity than MDD/TRD and AUD
* Prior or current substance abuse or dependence other than AUD (except for caffeine or nicotine dependence) and/or recent history (last 12 months) of cannabis abuse or dependence, as defined by DSM-5 criteria

  ○ In the context of its legalization, recreational use that does not meet criteria for a substance use disorder and/or is not deemed to be negatively impacting patients' physical and mental health will not justify the exclusion from the study just as it does not justify the exclusion from purely clinical treatment by ketamine
* The subject's depressive symptoms have previously demonstrated non-response to esketamine or ketamine in the current major depressive episode
* Known intellectual deficiency or autism spectrum disorder
* Unable to accommodate regular visits to the ketamine clinic at the CHUM
* Depression evaluated as secondary to stroke, cancer or other severe medical illnesses
* Known risk factors for intracranial hemorrhage, including previous significant trauma, known aneurysm, or previous neurosurgery
* Evidence of clinically relevant disease, e.g., uncontrolled hypertension, renal or hepatic impairment, significant coronary artery disease (myocardial infarct within a year prior to initial randomization), cerebrovascular disease, viral hepatitis B or C, acquired immunodeficiency syndrome
* Significant hearing impairment not improved with hearing aids and/or sound amplification or unwillingness to listen to music during treatment
* A positive toxicology screen for drugs that are not prescribed
* Unwilling or unable to hold benzodiazepines from the evening prior to the infusion of ketamine
* Unwilling or unable to hold alcohol for 24 hours prior to the infusion of ketamine
* Unwilling or unable to discontinue any narcotic beginning a minimum of 5 drug half-lives prior to infusion
* Unwilling or unable to discontinue memantine or lamotrigine (an NMDA antagonist) during infusions, beginning a minimum of 5 drug half-lives prior to infusions
* Pregnant, lactating, or of childbearing potential and not willing to use an approved method of contraception during the ketamine infusion, as per above

  ○ Female subjects of childbearing potential must have a negative urine pregnancy test at the beginning
* A clinical finding that is unstable or that, in the opinion of the treating clinician(s), would be negatively affected by, or would affect, the medication (e.g., diabetes mellitus, unstable angina)
* Liver function tests AST and ALT three times the upper normal limit at screening
* ECG results considered significantly abnormal as determined by the clinician(s)
* History of seizure disorder, except febrile convulsions
* Known history of intolerance or hypersensitivity to ketamine
* Acute psychotic symptoms, as judged by the initial clinical interview or reported by referring clinicians
* Any significant, recent, acute decline in exercise tolerance
* Uncorrected hypothyroidism or hyperthyroidism

  * Subjects needing a thyroid hormone supplement to treat hypothyroidism must have been on a stable dose of the medication for 3 months prior to beginning infusions
  * Clinically significant deviation from the reference range in clinical laboratory test results as judged by the clinician(s).

Primary outcomes:
measure: Patient adherence
timeFrame: From enrollment to the end of treatment at 8 weeks
Secondary outcomes:
measure: Recruitment rate
timeFrame: Before enrollment
measure: Consent rate
timeFrame: Before enrollment
measure: Attrition rate
timeFrame: From enrollment to the end of treatment at 8 weeks.
measure: Monitoring and recording of any adverse events of the intervention (Tolerability)
timeFrame: From enrollment to the end of treatment at 8 weeks.
measure: Incidence of Psychotherapy Adverse Events (Safety).
timeFrame: From enrollment to the end of treatment at 8 weeks
measure: Data collection rate
timeFrame: From enrollment to the end of treatment at 8 weeks
measure: Cost of the intervention (Resource utilization)
timeFrame: From enrollment to the end of treatment at 8 weeks
measure: Number of patients engaging in ACT in between therapy exercises
timeFrame: From enrollment to the end of treatment at 8 weeks
Other outcomes:
measure: Number of Participants with remission of Alcohol Use Disorder
timeFrame: From enrollment to the end of the follow-up (6 months)
measure: Multiple outcomes on Alcohol Use (including Frequency, Quantity, Abstinent day)
timeFrame: From enrollment to the end of the follow-up (6 months)
measure: Clinician-administered scale for reduction in depressive symptoms
timeFrame: From enrollment to the end of the follow-up (6 months)
measure: Self-administered scale for reduction in depressive symptoms
timeFrame: From enrollment to the end of the follow-up (6 months)
measure: Self-administered scale for reduction in anxiety symptoms
timeFrame: From enrollment to the end of the follow-up (6 months)
measure: Self-administered scale for reduction in Suicide Ideation
timeFrame: From enrollment to the end of the follow-up (6 months)
measure: Mystical Experience with Ketamine treatment
timeFrame: From the start of ketamine treatment to to the end of ketamine treatment (4 weeks)
measure: Emotional Breakthrough with Ketamine treatment
timeFrame: From the start of ketamine treatment to to the end of ketamine treatment (4 weeks)
measure: Mindfulness with Ketamine treatment
timeFrame: From the start of ketamine treatment to to the end of ketamine treatment (4 weeks)
measure: Change in quality of life
timeFrame: From enrollment to the end of the follow-up (6 months)
measure: Change in functioning
timeFrame: From enrollment to the end of the follow-up (6 months)
Locations:
city: Montreal
country: Canada
facility: Centre Hospitalier de l&#39;Université de Montréal
state: Quebec
Study officials:
affiliation: Centre Hospitalier d'Université de Montréal
name: Nicolas Garel, MD MSc
role: PRINCIPAL_INVESTIGATOR
References:
citation: Zhdanava M, Pilon D, Ghelerter I, Chow W, Joshi K, Lefebvre P, Sheehan JJ. The Prevalence and National Burden of Treatment-Resistant Depression and Major Depressive Disorder in the United States. J Clin Psychiatry. 2021 Mar 16;82(2):20m13699. doi: 10.4088/JCP.20m13699.
citation: Wood E, Bright J, Hsu K, Goel N, Ross JWG, Hanson A, Teed R, Poulin G, Denning B, Corace K, Chase C, Halpape K, Lim R, Kealey T, Rehm J; Canadian Alcohol Use Disorder Guideline Committee. Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder. CMAJ. 2023 Oct 16;195(40):E1364-E1379. doi: 10.1503/cmaj.230715.
citation: Wolff M, Evens R, Mertens LJ, Koslowski M, Betzler F, Grunder G, Jungaberle H. Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance. Front Psychiatry. 2020 Feb 21;11:5. doi: 10.3389/fpsyt.2020.00005. eCollection 2020.
citation: Wilkinson ST, Kitay BM, Harper A, Rhee TG, Sint K, Ghosh A, Lopez MO, Saenz S, Tsai J. Barriers to the Implementation of Electroconvulsive Therapy (ECT): Results From a Nationwide Survey of ECT Practitioners. Psychiatr Serv. 2021 Jul 1;72(7):752-757. doi: 10.1176/appi.ps.202000387. Epub 2021 May 11.
citation: Wikberg C, Nejati S, Larsson ME, Petersson EL, Westman J, Ariai N, Kivi M, Eriksson M, Eggertsen R, Hange D, Baigi A, Bjorkelund C. Comparison Between the Montgomery-Asberg Depression Rating Scale-Self and the Beck Depression Inventory II in Primary Care. Prim Care Companion CNS Disord. 2015 Jun 25;17(3):10.4088/PCC.14m01758. doi: 10.4088/PCC.14m01758. eCollection 2015.
citation: Walsh Z, Thiessen MS. Psychedelics and the new behaviourism: considering the integration of third-wave behaviour therapies with psychedelic-assisted therapy. Int Rev Psychiatry. 2018 Aug;30(4):343-349. doi: 10.1080/09540261.2018.1474088. Epub 2018 Sep 25.
citation: Ustun TB, Chatterji S, Kostanjsek N, Rehm J, Kennedy C, Epping-Jordan J, Saxena S, von Korff M, Pull C; WHO/NIH Joint Project. Developing the World Health Organization Disability Assessment Schedule 2.0. Bull World Health Organ. 2010 Nov 1;88(11):815-23. doi: 10.2471/BLT.09.067231. Epub 2010 May 20.
citation: Teresi JA, Yu X, Stewart AL, Hays RD. Guidelines for Designing and Evaluating Feasibility Pilot Studies. Med Care. 2022 Jan 1;60(1):95-103. doi: 10.1097/MLR.0000000000001664.
citation: Stubbs KR, Van Bezooyen J, Tang Y-l. Chapter 31 - Managing treatment-resistant depression with comorbid substance use disorders. In: Quevedo J, Riva-Posse P, Bobo WV, editors. Managing Treatment-Resistant Depression: Academic Press; 2022. p. 461-72.
citation: Strauss B, Gawlytta R, Schleu A, Frenzl D. Negative effects of psychotherapy: estimating the prevalence in a random national sample. BJPsych Open. 2021;7(6):e186.
citation: Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7. doi: 10.1001/archinte.166.10.1092.
citation: Souery D, Oswald P, Massat I, Bailer U, Bollen J, Demyttenaere K, Kasper S, Lecrubier Y, Montgomery S, Serretti A, Zohar J, Mendlewicz J; Group for the Study of Resistant Depression. Clinical factors associated with treatment resistance in major depressive disorder: results from a European multicenter study. J Clin Psychiatry. 2007 Jul;68(7):1062-70. doi: 10.4088/jcp.v68n0713.
citation: Sobell LC, Sobell MB. Timeline Follow-Back. In: Litten RZ, Allen JP, editors. Measuring Alcohol Consumption. Totowa, NJ: Humana Press; 1992. p. 41-72.
citation: Smout MF, Longo M, Harrison S, Minniti R, Wickes W, White JM. Psychosocial treatment for methamphetamine use disorders: a preliminary randomized controlled trial of cognitive behavior therapy and Acceptance and Commitment Therapy. Subst Abus. 2010 Apr;31(2):98-107. doi: 10.1080/08897071003641578.
citation: Smith-Apeldoorn SY, Veraart JK, Spijker J, Kamphuis J, Schoevers RA. Maintenance ketamine treatment for depression: a systematic review of efficacy, safety, and tolerability. Lancet Psychiatry. 2022 Nov;9(11):907-921. doi: 10.1016/S2215-0366(22)00317-0.
citation: Sloshower J, Guss J, Krause R, Wallace RM, Williams MT, Reed S, et al. Psilocybin-assisted therapy of major depressive disorder using Acceptance and Commitment Therapy as a therapeutic frame. Journal of Contextual Behavioral Science. 2020;15:12-9.
citation: Singleton EG, Gorelick DA. Mechanisms of alcohol craving and their clinical implications. Recent Dev Alcohol. 1998;14:177-95. doi: 10.1007/0-306-47148-5_8.
citation: Singleton E, Tiffany S, Henningfield J. Development and validation of a new questionnaire to assess craving for alcohol. NIDA Research Monograph. 1995;153:289-.
citation: Shallcross A, Lu NY, Hays RD. Evaluation of the Psychometric Properties of the Five Facet of Mindfulness Questionnaire. J Psychopathol Behav Assess. 2020 Jun;42(2):271-280. doi: 10.1007/s10862-019-09776-5. Epub 2020 Jan 10.
citation: Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 1993 Jun;88(6):791-804. doi: 10.1111/j.1360-0443.1993.tb02093.x.
citation: Saunders JB, Aasland OG, Amundsen A, Grant M. Alcohol consumption and related problems among primary health care patients: WHO collaborative project on early detection of persons with harmful alcohol consumption--I. Addiction. 1993 Mar;88(3):349-62. doi: 10.1111/j.1360-0443.1993.tb00822.x.
citation: Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000 Aug;23(4):334-40. doi: 10.1002/1098-240x(200008)23:43.0.co;2-g.
citation: Salani D, Goldin D, Valdes B, DeSantis J. Electroconvulsive Therapy for Treatment-Resistant Depression: Dispelling the Stigma. J Psychosoc Nurs Ment Health Serv. 2023 Jun;61(6):11-17. doi: 10.3928/02793695-20230222-02. Epub 2023 Mar 5.
citation: Sackeim HA. Modern Electroconvulsive Therapy: Vastly Improved yet Greatly Underused. JAMA Psychiatry. 2017 Aug 1;74(8):779-780. doi: 10.1001/jamapsychiatry.2017.1670. No abstract available.
citation: Rothberg RL, Azhari N, Haug NA, Dakwar E. Mystical-type experiences occasioned by ketamine mediate its impact on at-risk drinking: Results from a randomized, controlled trial. J Psychopharmacol. 2021 Feb;35(2):150-158. doi: 10.1177/0269881120970879. Epub 2020 Dec 13.
citation: Roseman L, Haijen E, Idialu-Ikato K, Kaelen M, Watts R, Carhart-Harris R. Emotional breakthrough and psychedelics: Validation of the Emotional Breakthrough Inventory. J Psychopharmacol. 2019 Sep;33(9):1076-1087. doi: 10.1177/0269881119855974. Epub 2019 Jul 11.
citation: Petersen TJ. Enhancing the efficacy of antidepressants with psychotherapy. J Psychopharmacol. 2006 May;20(3 Suppl):19-28. doi: 10.1177/1359786806064314.
citation: Papakostas GI, Thase ME, Fava M, Nelson JC, Shelton RC. Are antidepressant drugs that combine serotonergic and noradrenergic mechanisms of action more effective than the selective serotonin reuptake inhibitors in treating major depressive disorder? A meta-analysis of studies of newer agents. Biol Psychiatry. 2007 Dec 1;62(11):1217-27. doi: 10.1016/j.biopsych.2007.03.027. Epub 2007 Jun 22.
citation: Papakostas GI. Maintaining Rapid Antidepressant Effects Following Ketamine Infusion: A Major Unmet Need. J Clin Psychiatry. 2020 Feb 4;81(2):19r12859. doi: 10.4088/JCP.19r12859.
citation: Pahnke WN. Psychedelic drugs and mystical experience. Int Psychiatry Clin. 1969;5(4):149-62. No abstract available.
citation: Pahnke WN. Drugs and Mysticism: An Analysis of the Relationship Between Psychedelic Drugs and the Mystical Consciousness : a Thesis: Harvard University; 1963.
citation: Osaji J, Ojimba C, Ahmed S. The Use of Acceptance and Commitment Therapy in Substance Use Disorders: A Review of Literature. J Clin Med Res. 2020 Oct;12(10):629-633. doi: 10.14740/jocmr4311. Epub 2020 Sep 21.
citation: Oliveira-Maia AJ, Bobrowska A, Constant E, Ito T, Kambarov Y, Luedke H, Mulhern-Haughey S, von Holt C. Treatment-Resistant Depression in Real-World Clinical Practice: A Systematic Literature Review of Data from 2012 to 2022. Adv Ther. 2024 Jan;41(1):34-64. doi: 10.1007/s12325-023-02700-0. Epub 2023 Oct 26.
citation: Nikolin S, Rodgers A, Schwaab A, Bahji A, Zarate C Jr, Vazquez G, Loo C. Ketamine for the treatment of major depression: a systematic review and meta-analysis. EClinicalMedicine. 2023 Aug 3;62:102127. doi: 10.1016/j.eclinm.2023.102127. eCollection 2023 Aug.
citation: Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979 Apr;134:382-9. doi: 10.1192/bjp.134.4.382.
citation: Mollaahmetoglu OM, Keeler J, Ashbullby KJ, Ketzitzidou-Argyri E, Grabski M, Morgan CJA. "This Is Something That Changed My Life": A Qualitative Study of Patients' Experiences in a Clinical Trial of Ketamine Treatment for Alcohol Use Disorders. Front Psychiatry. 2021 Aug 16;12:695335. doi: 10.3389/fpsyt.2021.695335. eCollection 2021.
citation: Meis LA, Griffin JM, Greer N, Jensen AC, Macdonald R, Carlyle M, Rutks I, Wilt TJ. Couple and family involvement in adult mental health treatment: a systematic review. Clin Psychol Rev. 2013 Mar;33(2):275-86. doi: 10.1016/j.cpr.2012.12.003. Epub 2012 Dec 22.
citation: McPheeters M, O'Connor EA, Riley S, Kennedy SM, Voisin C, Kuznacic K, Coffey CP, Edlund MD, Bobashev G, Jonas DE. Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis. JAMA. 2023 Nov 7;330(17):1653-1665. doi: 10.1001/jama.2023.19761.
citation: McMullen EP, Lee Y, Lipsitz O, Lui LMW, Vinberg M, Ho R, Rodrigues NB, Rosenblat JD, Cao B, Gill H, Teopiz KM, Cha DS, McIntyre RS. Strategies to Prolong Ketamine's Efficacy in Adults with Treatment-Resistant Depression. Adv Ther. 2021 Jun;38(6):2795-2820. doi: 10.1007/s12325-021-01732-8. Epub 2021 Apr 30.
citation: McKiernan P, Cloud R, Patterson DA, Wolf Adelv Unegv Waya S, Golder S, Besel K. Development of a Brief Abstinence Self-Efficacy Measure. J Soc Work Pract Addict. 2011 Jul;11(3):245-253. doi: 10.1080/1533256X.2011.593445. Epub 2011 Aug 16.
citation: McIntyre RS, Alsuwaidan M, Baune BT, Berk M, Demyttenaere K, Goldberg JF, Gorwood P, Ho R, Kasper S, Kennedy SH, Ly-Uson J, Mansur RB, McAllister-Williams RH, Murrough JW, Nemeroff CB, Nierenberg AA, Rosenblat JD, Sanacora G, Schatzberg AF, Shelton R, Stahl SM, Trivedi MH, Vieta E, Vinberg M, Williams N, Young AH, Maj M. Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World Psychiatry. 2023 Oct;22(3):394-412. doi: 10.1002/wps.21120.
citation: McHugh RK, Weiss RD. Alcohol Use Disorder and Depressive Disorders. Alcohol Res. 2019 Jan 1;40(1):arcr.v40.1.01. doi: 10.35946/arcr.v40.1.01. eCollection 2019 Oct 21.
citation: Mathai DS, Mora V, Garcia-Romeu A. Toward Synergies of Ketamine and Psychotherapy. Front Psychol. 2022 Mar 25;13:868103. doi: 10.3389/fpsyg.2022.868103. eCollection 2022.
citation: Marini C, Northover NS, Gold ND, Rogers UK, O'Donnell KC, Tofighi B, Ross S, Bogenschutz MP. A Systematic Approach to Standardizing Drinking Outcomes From Timeline Followback Data. Subst Abuse. 2023 Mar 11;17:11782218231157558. doi: 10.1177/11782218231157558. eCollection 2023.
citation: Magill M, Ray L, Kiluk B, Hoadley A, Bernstein M, Tonigan JS, Carroll K. A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. J Consult Clin Psychol. 2019 Dec;87(12):1093-1105. doi: 10.1037/ccp0000447. Epub 2019 Oct 10.
citation: MacLeod MA, Tremblay PF, Graham K, Bernards S, Rehm J, Wells S. Psychometric properties and a latent class analysis of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in a pooled dataset of community samples. Int J Methods Psychiatr Res. 2016 Dec;25(4):243-254. doi: 10.1002/mpr.1523. Epub 2016 Sep 15.
citation: Maclean KA, Leoutsakos JM, Johnson MW, Griffiths RR. Factor Analysis of the Mystical Experience Questionnaire: A Study of Experiences Occasioned by the Hallucinogen Psilocybin. J Sci Study Relig. 2012 Dec;51(4):721-737. doi: 10.1111/j.1468-5906.2012.01685.x.
citation: Lee EB, An W, Levin ME, Twohig MP. An initial meta-analysis of Acceptance and Commitment Therapy for treating substance use disorders. Drug Alcohol Depend. 2015 Oct 1;155:1-7. doi: 10.1016/j.drugalcdep.2015.08.004. Epub 2015 Aug 13.
citation: Krystal JH, Abdallah CG, Sanacora G, Charney DS, Duman RS. Ketamine: A Paradigm Shift for Depression Research and Treatment. Neuron. 2019 Mar 6;101(5):774-778. doi: 10.1016/j.neuron.2019.02.005.
citation: Kryst J, Kawalec P, Mitoraj AM, Pilc A, Lason W, Brzostek T. Efficacy of single and repeated administration of ketamine in unipolar and bipolar depression: a meta-analysis of randomized clinical trials. Pharmacol Rep. 2020 Jun;72(3):543-562. doi: 10.1007/s43440-020-00097-z. Epub 2020 Apr 16.
citation: Kranzler HR, Soyka M. Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review. JAMA. 2018 Aug 28;320(8):815-824. doi: 10.1001/jama.2018.11406.
citation: Koob GF. Alcohol Use Disorder Treatment: Problems and Solutions. Annu Rev Pharmacol Toxicol. 2024 Jan 23;64:255-275. doi: 10.1146/annurev-pharmtox-031323-115847.
citation: Klein JP, Rozental A, Surig S, Moritz S. Adverse Events of Psychological Interventions: Definitions, Assessment, Current State of the Research and Implications for Research and Clinical Practice. Psychother Psychosom. 2024;93(5):308-315. doi: 10.1159/000540212. Epub 2024 Jul 29.
citation: Klatte R, Strauss B, Fluckiger C, Rosendahl J. Adverse events in psychotherapy randomized controlled trials: A systematic review. Psychother Res. 2025 Jan;35(1):84-99. doi: 10.1080/10503307.2023.2286992. Epub 2023 Dec 13.
citation: Kang MJY, Hawken E, Vazquez GH. The Mechanisms Behind Rapid Antidepressant Effects of Ketamine: A Systematic Review With a Focus on Molecular Neuroplasticity. Front Psychiatry. 2022 Apr 25;13:860882. doi: 10.3389/fpsyt.2022.860882. eCollection 2022.
citation: Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, Kim MM, Shanahan E, Gass CE, Rowe CJ, Garbutt JC. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014 May 14;311(18):1889-900. doi: 10.1001/jama.2014.3628.
citation: Jimenez M, Grana JL, Montes V, Rubio G. Alcohol craving scale based on three factors. Eur Addict Res. 2009;15(3):135-42. doi: 10.1159/000210043. Epub 2009 Mar 31.
citation: Hunt GE, Malhi GS, Lai HMX, Cleary M. Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990-2019: Systematic review and meta-analysis. J Affect Disord. 2020 Apr 1;266:288-304. doi: 10.1016/j.jad.2020.01.141. Epub 2020 Jan 26.
citation: Hoeppner BB, Stout RL, Jackson KM, Barnett NP. How good is fine-grained Timeline Follow-back data? Comparing 30-day TLFB and repeated 7-day TLFB alcohol consumption reports on the person and daily level. Addict Behav. 2010 Dec;35(12):1138-43. doi: 10.1016/j.addbeh.2010.08.013. Epub 2010 Aug 13.
citation: Higgins-Biddle JC, Babor TF. A review of the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and USAUDIT for screening in the United States: Past issues and future directions. Am J Drug Alcohol Abuse. 2018;44(6):578-586. doi: 10.1080/00952990.2018.1456545. Epub 2018 May 3.
citation: Hermida AP, Glass OM, Shafi H, McDonald WM. Electroconvulsive Therapy in Depression: Current Practice and Future Direction. Psychiatr Clin North Am. 2018 Sep;41(3):341-353. doi: 10.1016/j.psc.2018.04.001. Epub 2018 Jun 15.
citation: Henssler J, Kurschus M, Franklin J, Bschor T, Baethge C. Trajectories of Acute Antidepressant Efficacy: How Long to Wait for Response? A Systematic Review and Meta-Analysis of Long-Term, Placebo-Controlled Acute Treatment Trials. J Clin Psychiatry. 2018 May/Jun;79(3):17r11470. doi: 10.4088/JCP.17r11470.
citation: Henssler J, Alexander D, Schwarzer G, Bschor T, Baethge C. Combining Antidepressants vs Antidepressant Monotherapy for Treatment of Patients With Acute Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2022 Apr 1;79(4):300-312. doi: 10.1001/jamapsychiatry.2021.4313.
citation: Heerlein K, Perugi G, Otte C, Frodl T, Degraeve G, Hagedoorn W, Oliveira-Maia AJ, Perez Sola V, Rathod S, Rosso G, Sierra P, Malynn S, Morrens J, Verrijcken C, Gonzalez B, Young AH. Real-world evidence from a European cohort study of patients with treatment resistant depression: Treatment patterns and clinical outcomes. J Affect Disord. 2021 Jul 1;290:334-344. doi: 10.1016/j.jad.2021.03.073. Epub 2021 Apr 1.
citation: Hayes SC, Wilson KG, Gifford EV, Bissett R, Piasecki M, Batten SV, et al. A Preliminary trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance-abusing methadone-maintained opiate addicts. Behavior Therapy. 2004;35(4):667-88.
citation: Hasin DS, Wall M, Witkiewitz K, Kranzler HR, Falk D, Litten R, Mann K, O'Malley SS, Scodes J, Robinson RL, Anton R; Alcohol Clinical Trials Initiative (ACTIVE) Workgroup. Change in non-abstinent WHO drinking risk levels and alcohol dependence: a 3 year follow-up study in the US general population. Lancet Psychiatry. 2017 Jun;4(6):469-476. doi: 10.1016/S2215-0366(17)30130-X. Epub 2017 Apr 26.
citation: Hasin DS, Sarvet AL, Meyers JL, Saha TD, Ruan WJ, Stohl M, Grant BF. Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States. JAMA Psychiatry. 2018 Apr 1;75(4):336-346. doi: 10.1001/jamapsychiatry.2017.4602.
citation: Hall W, Saunders JB, Babor TF, Aasland OG, Amundsen A, Hodgson R, Grant M. The structure and correlates of alcohol dependence: WHO collaborative project on the early detection of persons with harmful alcohol consumption--III. Addiction. 1993 Dec;88(12):1627-36. doi: 10.1111/j.1360-0443.1993.tb02037.x.
citation: Grant S, Azhar G, Han E, Booth M, Motala A, Larkin J, Hempel S. Clinical interventions for adults with comorbid alcohol use and depressive disorders: A systematic review and network meta-analysis. PLoS Med. 2021 Oct 8;18(10):e1003822. doi: 10.1371/journal.pmed.1003822. eCollection 2021 Oct.
citation: Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015 Aug;72(8):757-66. doi: 10.1001/jamapsychiatry.2015.0584.
citation: Grabski M, McAndrew A, Lawn W, Marsh B, Raymen L, Stevens T, Hardy L, Warren F, Bloomfield M, Borissova A, Maschauer E, Broomby R, Price R, Coathup R, Gilhooly D, Palmer E, Gordon-Williams R, Hill R, Harris J, Mollaahmetoglu OM, Curran HV, Brandner B, Lingford-Hughes A, Morgan CJA. Adjunctive Ketamine With Relapse Prevention-Based Psychological Therapy in the Treatment of Alcohol Use Disorder. Am J Psychiatry. 2022 Feb;179(2):152-162. doi: 10.1176/appi.ajp.2021.21030277. Epub 2022 Jan 11.
citation: Feng YS, Kohlmann T, Janssen MF, Buchholz I. Psychometric properties of the EQ-5D-5L: a systematic review of the literature. Qual Life Res. 2021 Mar;30(3):647-673. doi: 10.1007/s11136-020-02688-y. Epub 2020 Dec 7.
citation: Felton JW, Strutz KL, McCauley HL, Poland CA, Barnhart KJ, Lejuez CW. Delay Discounting Interacts with Distress Tolerance to Predict Depression and Alcohol Use Disorders among Individuals Receiving Inpatient Substance Use Services. Int J Ment Health Addict. 2020 Oct;18(5):1416-1421. doi: 10.1007/s11469-019-00163-5. Epub 2019 Nov 14.
citation: Espinoza RT, Kellner CH. Electroconvulsive Therapy. N Engl J Med. 2022 Feb 17;386(7):667-672. doi: 10.1056/NEJMra2034954. No abstract available.
citation: DiClemente CC, Carbonari JP, Montgomery RP, Hughes SO. The Alcohol Abstinence Self-Efficacy scale. J Stud Alcohol. 1994 Mar;55(2):141-8. doi: 10.15288/jsa.1994.55.141.
citation: Devlin N, Pickard S, Busschbach J. The Development of the EQ-5D-5L and its Value Sets. In: Devlin N, Roudijk B, Ludwig K, editors. Value Sets for EQ-5D-5L: A Compendium, Comparative Review &amp;amp;amp;amp;amp;amp;amp; User Guide. Cham (CH): Springer Copyright 2022, The Author(s). 2022. p. 1-12.
citation: de Jonghe F, Kool S, van Aalst G, Dekker J, Peen J. Combining psychotherapy and antidepressants in the treatment of depression. J Affect Disord. 2001 May;64(2-3):217-29. doi: 10.1016/s0165-0327(00)00259-7.
citation: Davis AK, Barrett FS, Griffiths RR. Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. J Contextual Behav Sci. 2020 Jan;15:39-45. doi: 10.1016/j.jcbs.2019.11.004. Epub 2019 Nov 16.
citation: Davidson J, Turnbull CD, Strickland R, Miller R, Graves K. The Montgomery-Asberg Depression Scale: reliability and validity. Acta Psychiatr Scand. 1986 May;73(5):544-8. doi: 10.1111/j.1600-0447.1986.tb02723.x.
citation: Das RK, Gale G, Walsh K, Hennessy VE, Iskandar G, Mordecai LA, Brandner B, Kindt M, Curran HV, Kamboj SK. Ketamine can reduce harmful drinking by pharmacologically rewriting drinking memories. Nat Commun. 2019 Nov 26;10(1):5187. doi: 10.1038/s41467-019-13162-w.
citation: Dakwar E, Levin F, Hart CL, Basaraba C, Choi J, Pavlicova M, Nunes EV. A Single Ketamine Infusion Combined With Motivational Enhancement Therapy for Alcohol Use Disorder: A Randomized Midazolam-Controlled Pilot Trial. Am J Psychiatry. 2020 Feb 1;177(2):125-133. doi: 10.1176/appi.ajp.2019.19070684. Epub 2019 Dec 2.
citation: Craighead WE, Dunlop BW. Combination psychotherapy and antidepressant medication treatment for depression: for whom, when, and how. Annu Rev Psychol. 2014;65:267-300. doi: 10.1146/annurev.psych.121208.131653. Epub 2013 Sep 13.
citation: Conigrave KM, Hall WD, Saunders JB. The AUDIT questionnaire: choosing a cut-off score. Alcohol Use Disorder Identification Test. Addiction. 1995 Oct;90(10):1349-56. doi: 10.1046/j.1360-0443.1995.901013496.x.
citation: Close JB, Hajien EC, Watts R, Roseman L, Carhart-Harris RL. Psychedelics and psychological flexibility - Results of a prospective web-survey using the Acceptance and Action Questionnaire II. Journal of Contextual Behavioral Science. 2020;16:37-44.
citation: Carvalho AF, Heilig M, Perez A, Probst C, Rehm J. Alcohol use disorders. Lancet. 2019 Aug 31;394(10200):781-792. doi: 10.1016/S0140-6736(19)31775-1.
citation: Bschor T, Kern H, Henssler J, Baethge C. Switching the Antidepressant After Nonresponse in Adults With Major Depression: A Systematic Literature Search and Meta-Analysis. J Clin Psychiatry. 2018 Jan/Feb;79(1):16r10749. doi: 10.4088/JCP.16r10749.
citation: Brenner P, Brandt L, Li G, DiBernardo A, Boden R, Reutfors J. Substance use disorders and risk for treatment resistant depression: a population-based, nested case-control study. Addiction. 2020 Apr;115(4):768-777. doi: 10.1111/add.14866. Epub 2019 Dec 16.
citation: Bohn MJ, Babor TF, Kranzler HR. The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings. J Stud Alcohol. 1995 Jul;56(4):423-32. doi: 10.15288/jsa.1995.56.423.
citation: Bilbao A, Martin-Fernandez J, Garcia-Perez L, Mendezona JI, Arrasate M, Candela R, Acosta FJ, Estebanez S, Retolaza A. Psychometric properties of the EQ-5D-5L in patients with major depression: factor analysis and Rasch analysis. J Ment Health. 2022 Aug;31(4):506-516. doi: 10.1080/09638237.2021.1875422. Epub 2021 Feb 1.
citation: Bernstein EY, Baggett TP, Trivedi S, Herzig SJ, Anderson TS. Pharmacologic Treatment Initiation Among Medicare Beneficiaries Hospitalized With Alcohol Use Disorder. Ann Intern Med. 2023 Aug;176(8):1137-1139. doi: 10.7326/M23-0641. Epub 2023 Jun 27. No abstract available.
citation: Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996 Dec;67(3):588-97. doi: 10.1207/s15327752jpa6703_13.
citation: Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the Scale for Suicide Ideation. J Consult Clin Psychol. 1979 Apr;47(2):343-52. doi: 10.1037//0022-006x.47.2.343. No abstract available.
citation: Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006 Mar;13(1):27-45. doi: 10.1177/1073191105283504.
citation: Anton RF, Moak DH, Latham PK. The obsessive compulsive drinking scale: A new method of assessing outcome in alcoholism treatment studies. Arch Gen Psychiatry. 1996 Mar;53(3):225-31. doi: 10.1001/archpsyc.1996.01830030047008.
citation: Anton RF, Moak DH, Latham P. The Obsessive Compulsive Drinking Scale: a self-rated instrument for the quantification of thoughts about alcohol and drinking behavior. Alcohol Clin Exp Res. 1995 Feb;19(1):92-9. doi: 10.1111/j.1530-0277.1995.tb01475.x.
citation: Anand A, Mathew SJ, Sanacora G, Murrough JW, Goes FS, Altinay M, Aloysi AS, Asghar-Ali AA, Barnett BS, Chang LC, Collins KA, Costi S, Iqbal S, Jha MK, Krishnan K, Malone DA, Nikayin S, Nissen SE, Ostroff RB, Reti IM, Wilkinson ST, Wolski K, Hu B. Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. N Engl J Med. 2023 Jun 22;388(25):2315-2325. doi: 10.1056/NEJMoa2302399. Epub 2023 May 24.
citation: Alsheikh AM, Elemam MO, El-Bahnasawi M. Treatment of Depression With Alcohol and Substance Dependence: A Systematic Review. Cureus. 2020 Oct 26;12(10):e11168. doi: 10.7759/cureus.11168.
citation: Alnefeesi Y, Chen-Li D, Krane E, Jawad MY, Rodrigues NB, Ceban F, Di Vincenzo JD, Meshkat S, Ho RCM, Gill H, Teopiz KM, Cao B, Lee Y, McIntyre RS, Rosenblat JD. Real-world effectiveness of ketamine in treatment-resistant depression: A systematic review & meta-analysis. J Psychiatr Res. 2022 Jul;151:693-709. doi: 10.1016/j.jpsychires.2022.04.037. Epub 2022 May 25.
citation: Allen JP, Litten RZ, Fertig JB, Babor T. A review of research on the Alcohol Use Disorders Identification Test (AUDIT). Alcohol Clin Exp Res. 1997 Jun;21(4):613-9.