Can Selfcompassion Training Reduce Alcohol Consumption in Patients With Alcohol Use Disosrder ?

Context:

Alcohol Use Disorders (AUD, ICD-10, DSM-5) affect more than 11% of men and 3% of women in France, leading to over 200 diseases and 41,000 deaths annually, primarily due to alcohol-related cancers. The current management of patients with AUD is based on a combination of pharmacological and psychotherapeutic treatments. However, 60% of patients at 6 months and 70% at 1 year fail to significantly reduce their alcohol consumption or maintain abstinence. Therefore, it is crucial to explore new complementary therapeutic strategies.

Self-compassion involves treating oneself with the same kindness, attention, and understanding that we extend to others in times of suffering. Several studies suggest that self-compassion is a key factor in promoting proactive health behaviors and improving adherence in conditions such as diabetes, HIV-related illnesses, and schizophrenia. Individuals with AUD tend to have lower levels of self-compassion compared to the general population, whereas higher levels of self-compassion have shown protective effects against the development and persistence of AUD.

Objectives :

The primary objective is to evaluate the effectiveness of the Mindful Self-Compassion (MSC) program in reducing alcohol consumption among individuals with AUD, measured by the number of heavy drinking days assessed using the Timeline Follow-Back (TLFB) method, six months after treatment completion.

The secondary objectives include evaluating the impact of the MSC program on reducing alcohol consumption by comparing the number of heavy drinking days at one and three months, as well as the total number of drinking days at one, three, and six months between groups using the TLFB method. Biomarkers CDT and GGT will be analyzed at one, three, and six months post-intervention to compare blood values.

The program's impact on psychological and behavioral factors will also be assessed using standardized scales at one, three, and six months.

Finally, program satisfaction and adherence will be measured using the CSQ-8 scale, session attendance rates, and the percentage of program completion (≥6/8 MSC sessions).

Research Hypothesis :

Alcohol consumption will be significantly reduced in the group of patients who complete the MSC program compared to the group receiving only standard treatment (Treatment As Usual: TAU).

Method :

This is a prospective, randomized, controlled, multicenter, single-blind, parallel-group interventional study RIPH2 (French interventional research category). The study follows the CONsolidated Standards of Reporting Trials (CONSORT) 2010 guidelines, updated in 2025.

Adult outpatients with AUD (ICD-10 and DSM-5 criteria) will be included after verification of eligibility criteria and the collection of informed consent. Participants will be randomized to one of the following groups:

• MSC+TAU group: receiving self-compassion training with the MSC program in addition to standard treatment
• TAU group: receiving only standard treatment Each participant will complete 13 visits over 9 months. The MSC+TAU group will attend 9 MSC sessions and 9 TAU sessions (18 sessions in total), while the TAU group will attend 18 TAU sessions. Follow-up assessments will take place at 1, 3, and 6 months after the final session. Participants will exit the study after 245 days (9 months) of follow-up.

The study aims to recruit 152 participants over 24 months across three centers (EPS Barthélemy Durand, Paul Brousse University Hospital, EPSM de l'Oise, CHI Montdidier), with an expected start date of October 2025 and a total study duration of 36 months.

Expected public health impact :

Self-compassion training with the MSC program is expected to significantly reduce alcohol consumption in individuals with AUD. If the results are positive, the MSC program could facilitate alcohol reduction, potentially lowering the risk of alcohol-related disorders, particularly alcohol-induced cancers (e.g., larynx, pharynx, esophagus, breast, liver, bladder, etc.).

Perspectives :

If effective, the MSC self-compassion training program could be implemented in clinical practice to help patients with AUD who are not yet ready to quit drinking but need a supportive approach to reduce their alcohol consumption.

Inclusion criteria

• Adults aged 18 to 75 years.
• Subjects meeting DSM-5 criteria for Alcohol Use Disorder (AUD).
• Subjects receiving outpatient care in addiction services, CSAPA, CMP, day hospitals, mental health care institutions, community mental health centers.
• Subjects affiliated with the social security system.
• Subjects who have a good understanding of French languague, allowing them to provide informed consent, respond to self-questionnaires, and participate in the MSC program.

Exclusion criteria

• Subjects unable to understand the questionnaires.
• Subjects presenting moderate or severe suicidal ideation (assessed by the Suicide item of the MINI scale).
• Subjects with a score <10 on the MoCA version 7.1 test.
• Subjects admitted to inpatient units (since hospitalization alters alcohol consumption).
• Subjects unable to provide informed or voluntary consent to participate in the study.
• Subjects under guardianship or curatorship.