Brief acceptance and commitment therapy added to medication management during acute alcohol detoxification: A pilot randomized controlled effectiveness trial

Alcohol detoxification inevitably involves physical and emotional discomfort in the form of withdrawal symptoms. Clinical management typically involves pharmacologic treatment with benzodiazepines. The current pilot study examined the incremental efficacy of adding elements from Acceptance and Commitment Therapy (ACT) to standard of care medication management (i.e., treatment as usual [TAU]) at a residential rehabilitation facility. The ACT protocol included two 30-45 min sessions, based on the ACT matrix, and brief (5-10 min) daily skills coaching. Forty-five adults (Mage=42.4 years, 47% female, 84% white) with alcohol use disorder and experiencing severe withdrawal symptoms were randomized to either ACT + TAU (n = 22) or TAU (n = 23) and spent an average of 4 days in detoxification. At exit the ACT + TAU group reported greater positive changes in daily psychological flexibility (F = 4.62, p = .04), overall psychological inflexibility (F = 7.97, p = .01 and F = 2.92, p < .10), but not overall flexibility (F = 0.21, p = .65), connection with chosen values (t = 2.01, p = .05), and withdrawal symptoms (F = 4.02, p = .05 and F = 3.42, p = .07). The number of ACT coaching sessions correlated significantly with change in daily psychological flexibility (r = 0.44, p < .05). Change on one measure of psychological inflexibility mediated change on one measure of withdrawal (ab = -0.32 [SE = 0.15, 95% CI: 0.67 to - 0.08]) and change in daily psychological flexibility mediated patient satisfaction (ab = 1.05 [SE = 0.74, 95% CI: 0.05 to 2.87]). Results suggest a potential benefit of adding ACT elements to medication management in acute alcohol detoxification. Replication and extension is necessary to warrant stronger conclusions.