Glass-Box Testing the Centre for Addiction and Mental Health Integrated Care Pathway for Major Depressive and Alcohol Use Disorders: Is It More Than a Sum of Its Components?

ABSTRACT Objectives: Integrated care pathways (ICP) have been successfully developed in multiple areas of medicine with evidence supporting their superior effectiveness when compared to treatment as usual (TAU). There are lack of data indicating that specifically integration of services plays a crucial role in ICP effectiveness rather than simple combination of effective treatment techniques for concurrent major depressive and alcohol use disorders. Methods: A clinical chart review was completed to compare patients receiving ICP to those receiving TAU analyzed by univariate and multivariate regression models to see if allocation to ICP would be a significant determinant of reduction in drinking. Results: Of the 237 patients included into the analyses, 133 patients received ICP treatment and 104 received TAU. Patients were similar in their demographics, but there were differences in several baseline characteristics, 2 of which were significantly associated with reduction of drinking as the primary outcome—baseline alcohol consumption measured as standard drinks per week [SD/w; β = −0.24, 95% confidence interval (CI) −0.38 to −0.10, P < 0.001] and cannabis use (β = −17.58, 95% CI −30.89 to −4.28, P < 0.01). Receiving ICP treatment versus TAU was associated with significantly higher reduction in drinking (β = 40.23, 95% CI 30.39 to 52.26, P < 0.001). Almost all treatment parameters were associated with reduction in drinking in univariate analyses and after adjusting for baseline SD/w and cannabis use. In multivariate models only treatment model (β = 27.23, 95% CI 12.47 to 41.99, P < 0.001), baseline SD/w and cannabis use contributed significantly; the assignment to integrated treatment group explained 72% of the variability. Conclusions: ICP treatment model is associated with superior treatment outcomes in comparison to TAU. Integration of treatment techniques seems to be more important that the techniques themselves or their intensity.