[New possibilities in therapy and rehabilitation of alcohol dependent patients. Catamnestic study of the efficacy of ambulatory withdrawal therapy exemplified by a model facility]

Outpatient alcoholism treatment: predictors of outcome after 3 years

AIMS

This prospective study investigated predictors for relapse 3 years after completion of an intensive outpatient treatment programme for alcoholism.

DESIGN

As previous studies mainly revealed that severity of alcohol dependence, and comorbid psychopathology were predictive for subsequent relapses, the impact of these and other pre-treatment variables on the 36-month outcome was evaluated in a logistic regression analysis. A structured interview was used to assess the variables. Patients were personally interviewed at entry to, and the end of, an outpatient treatment programme, and 6, 12, 24 and 36 months after the end of treatment. One hundred and three alcohol-dependent participants who were taking part in an outpatient treatment were consecutively recruited.

RESULTS

Seventy-four patients completed the treatment programme. At the follow-up after 36 months, 2 patients had died (after heavy alcohol relapse) and 88 (88%) of the remaining patients could be located and personally re-interviewed. Forty-four (43%) patients were abstinent, 46 (45%) had relapsed and 12 (12%) were classified as improved for the total follow-up period according to the classification proposed by Feuerlein and Küfner. Based on a logistic regression analysis, significant variables for prediction of relapse were treatment drop-outs, female sex and sum of positive life events prior to treatment (relapsers had significantly fewer positive life events).

CONCLUSIONS

In contrast to previous studies we could not confirm the importance of determinants known as risk factors for relapse like severity of alcohol dependence. The strongest predictor for relapsing after treatment is treatment drop-out. Since women were at an increased risk for relapse gender-specific treatment approaches should be considered. In summary, the effectiveness of the studied intensive outpatient treatment programme, with an abstinence rate of 43% for the total follow-up period of 3 years, is favourable although selection criteria of must be taken into account.

Efficacy of an intensive outpatient rehabilitation program in alcoholism: predictors of outcome 6 months after treatment

Treatment of alcohol-dependent patients was primarily focused on inpatient settings in the past decades. The efficacy of these treatment programs has been evaluated in several studies and proven to be sufficient. However, with regard to the increasing costs in public healthcare systems, questions about alternative treatment strategies have been raised. Meanwhile, there is growing evidence that outpatient treatment might be comparably effective as inpatient treatment, at least for subgroups of alcohol dependents. On that background, the present study aimed to evaluate the efficacy of a high-structured outpatient treatment program in 103 alcohol-dependent patients. 74 patients (72%) terminated the outpatient treatment regularly. At 6 months' follow-up, 95% patients were successfully located and personally re-interviewed. Analyses revealed that 65 patients (64%) were abstinent at the 6-month follow-up evaluation and 37 patients (36%) were judged to be non-abstinent. Pre-treatment variables which were found to have a negative impact (non-abstinence) on the 6-month outcome after treatment were a higher severity of alcohol dependence measured by a longer duration of alcohol dependence, a higher number of prior treatments and a stronger alcohol craving (measured by the Obsessive Compulsive Drinking Scale). Further patients with a higher degree of psychopathology measured by the Beck Depression Inventory (depression) and State-Trait Anxiety Inventory (anxiety) relapsed more often. In summary, results of this study indicate a favorable outcome of socially stable alcohol-dependent patients and patients with a lower degree of depression, anxiety and craving in an intensive outpatient rehabilitation program.

Therapy and supportive care of alcoholics: guidelines for practitioners

Alcohol dependence is one of the most pervasive diseases of the Western world. However, less than 5% of all patients receive proper treatment. Each year, about 30% of all alcohol-dependent patients are admitted to general hospitals, usually to treat alcohol-related physical diseases. The alcohol dependence itself, however, is often not diagnosed or is ignored. This chapter describes current neurobiological findings, which help in the diagnosis and understanding of the development of alcohol tolerance, withdrawal and craving. It also discusses evidence-based treatment options that include brief interventions, outpatient programmes, self-help groups and medication to reduce the relapse risk. The state-of-the-art would be to develop a therapeutical network that offers a menu of treatment options for alcohol-dependent patients. If adequate treatment is available, relapse rates were as low as 50% in those follow-up studies that examined treatment periods of up to 2 years, so that there is no justification for therapeutic nihilism.