Out-patient behaviour therapy in alcoholism: treatment outcome after 2 years

OBJECTIVE

The main aim of the study was the evaluation of out-patient behavioural approaches in alcohol dependence. Additionally, the persistence of treatment effects and the impact of psychiatric comorbidity in long-term follow-up was examined.

METHOD

A total of 120 patients were randomly assigned to non-specific supportive therapy or to two different behavioural therapy programmes (coping skills training and cognitive therapy) each comprising 26 weekly sessions; the follow-up period lasted 2 years.

RESULTS

Patients undergoing behavioural therapy showed a consistent trend towards higher abstinence rates; significant differences between the two behavioural strategies could not be established. Moreover, the results indicate a reduced ability of cognitive impaired patients to cope with short-time abstinence violations and at a reduced benefit from behavioural techniques for patients with severe personality disorders.

CONCLUSION

Behavioural treatment yielded long-lasting effects and met high acceptance; yet, still in need of improvement is the development of specific programmes for high-risk patients.

[Interferon-induced paranoid psychosis. Review of the literature and case report]

Adverse neuropsychiatric effects under interferon treatment have often been reported. However, the pathogenetic mechanisms have not yet been fully explored. Most frequent are affective disorders, but psychotic decompensations can also occur, as reported in the following case. Thus, taking a detailed psychiatric history is required before starting a therapy with interferon, since past and current psychiatric disorders might imply an increased risk for psychiatric adverse effects.

Alcohol dependence and gender-role orientation

OBJECTIVE

The overall increase of female alcoholism is supposed to be associated with the change of the traditional female role, and it is especially seen as a consequence of role convergence or gender-role conflicts. The aim of the present pilot study is to explore whether the approach of gender-role orientation would be empirically useful in contributing to these hypotheses.

METHOD

One hundred twelve patients with alcohol dependence meeting DSM-III-R criteria were explored after detoxification; gender-role orientation was measured by a German version of the "Extended Personal Attributes Questionnaire", categorising gender-role orientation into four subgroups: masculine, feminine, androgynous, and undifferentiated.

RESULTS

In comparison with a population-based sample, there are significant differences in the distribution of the four subgroups of gender-role orientation, showing a predominance of the undifferentiated self-concept in the alcoholic sample (49%). Alcoholic females describe themselves as rather undifferentiated, and rather feminine than masculine. Low masculinity and low femininity, as well as high femininity, correlate positively with distress, depressiveness, social anxiety, insecurity and concomitant personality disorders.

CONCLUSION

Our data do not support the convergence hypothesis related to gender-role orientation, but support the traditional feminine self-concept as an unspecific risk factor for vulnerability. The question whether an undifferentiated self-concept could be a specific risk factor for alcoholism is discussed.

[Outpatient behavioural treatment in alcoholism: alcohol consumption and sociodemographic factors]

In spite of the increasing interest in outpatient treatment programmes for alcohol dependents, there still exist only a few experimental studies on this issue. Moreover, the interaction between abstinence and sociodemographic factors has been only rarely explored. In this study, the efficiency of different behaviour therapy strategies was examined: 120 patients were randomly assigned to nonspecific supportive therapy or to 2 forms of behavioural therapy (coping skills training and cognitive therapy). Behavioural treatment comprised 26 weekly sessions; follow-up examinations took place every 6 months over 2 years. Patients undergoing behavioural therapy showed less drop outs and significantly higher rates of abstinence and also of reemployment and satisfaction with their job situation compared to those under supportive treatment. At the same time, the employment status proved to be a valid predictor of treatment success, whereas there was only a weak (negative) impact of an existing partnership on abstinence. Statistically significant differences between the 2 behavioural therapy strategies could be established in neither respect.

Comorbid anxiety and affective disorder in alcohol-dependent patients seeking treatment: the first Multicentre Study in Germany

The goals of this study were to describe demographic variables, drinking history, and the 6-month prevalence of Axis I comorbidity among alcohol-dependent subjects in GERMANY: The variables: amount of alcohol consumption, age at onset of the first alcohol consumed, age at onset of daily alcohol consumption, age at onset of withdrawal symptoms and number of detoxifications were related to the different comorbid disorders and gender. In this study, 556 patients from 25 alcohol treatment centres were enrolled between 1 January 1999 and 30 April 1999. After a minimum of 10 days of sobriety patients who fulfilled ICD-10 and DSM-IV criteria of alcohol dependence were interviewed for data collection using the Mini-DIPS (German version of the Anxiety Disorders Interview Schedule) and a standardized psychosocial interview. The 6-month prevalence of comorbid Axis I disorders was 53.1%. Among the patients with comorbidity, affective and anxiety disorders were most frequent. Comorbid stress disorder was associated with an early start of drinking, an early beginning of withdrawal symptoms, highest number of detoxifications, and the highest amount of alcohol consumed. Female patients with anxiety disorder consumed more alcohol and started earlier than females without this comorbid disorder. The data do not answer the question of the pathogenesis of comorbid disorders and alcoholism, but indicate that stress disorders in alcoholic patients and anxiety disorders in female alcoholics influence the course and severity of alcoholism.

Out-patient behaviour therapy in alcoholism: impact of personality disorders and cognitive impairments

OBJECTIVE

We investigated whether alcoholic patients with comorbid personality disorders and those with cognitive impairments would benefit in a different way from different behaviour therapy strategies.

METHOD

After detoxification, 120 alcoholics were assigned randomly to one of three out-patient treatment programmes comprising 'coping skills training', 'cognitive behaviour therapy' or unspecific supportive control therapy. Personality disorders and cognitive impairments were assessed at the beginning of the 6-month treatment period.

RESULTS

The impact of concomitant personality disorders or cognitive impairments was generally only moderate and mainly independent from treatment condition. However, alcoholic patients relapsing within 6 months after detoxification showed a higher rate of personality disorders (especially antisocial and borderline) and slightly more cognitive deficits (especially in verbal memory and visuomotor functions) than abstainers even before therapy.

CONCLUSION

The high amount of early relapses and drop-outs probably hindered larger differentiated treatment effects. Hypotheses will be retested in treatment completers using forthcoming follow-up data.

Out-patient behaviour therapy in alcoholism: relapse rates after 6 months

OBJECTIVE

In spite of the increasing interest in out-patient treatment programmes for alcoholics, there still exist only a few experimental studies on this issue. In this still ongoing study the efficacy of different behaviour therapy strategies is to be examined.

METHOD

One hundred and twenty patients were assigned randomly to non-specific supportive therapy or to two forms of behavioural therapy (coping skills training and cognitive therapy). Behavioural treatment comprised 26 weekly sessions; follow-up examinations will take place every 6 months over 2 years.

RESULTS

Patients undergoing behavioural therapy showed less drop-outs and significantly higher rates of abstinence compared with supportive treatment. Nevertheless, statistically significant differences between the two behavioural therapy strategies could not be established so far.

CONCLUSION

Preliminary results demonstrate the feasibility and efficacy of behaviour therapy programmes in the out-patient treatment of alcoholism. Furthermore, they stress the importance of professional psychiatric and psychotherapeutic engagement in the field of addiction.

[Antagonist-induced opiate detoxification. Report on clinical experience as well as on short and intermediate range course]

In a special inpatient unit for detoxification treatment of illicit drugs, antagonist-induced opiate detoxification was studied in five nonselected inpatients with polytoxicomanic abuse. The purpose was to evaluate the feasibility of this detoxification method and its impact on further reaction to treatment. During rapid detoxification under general anesthesia in an intensive care unit, no complications occurred. Withdrawal symptoms were observed in all patients over several days. During the inpatient period, no patient could be motivated to take part in a longer rehabilitation therapy. Most patients were discharged prematurely on their own demand and none made use of the rehabilitation program offered to them. All patients relapsed after relatively short times and three out of five presented for a new detoxification treatment.

[Behavioral therapeutic methods in ambulatory treatment of alcoholism. Early results of an experimental study]

Outpatient alcoholism treatment programs are widespread especially in the United States and in Great Britain. However, there still exist only a few experimental studies investigating the numerous questions arising from this field. In this still ongoing project 120 patients were randomly assigned to 3 different outpatient group therapy programs: unspecific supportive therapy and 2 forms of behavioural therapy--coping skills training [17] and cognitive therapy according to Beck [2]. The main hypotheses to be tested are that both forms of behavioural therapy will prove superior to supportive treatment and that patients with a comorbidity of personality disorders will profit in a different way from these differentiated intervention strategies. Treatment lasted 6 months; first results obtained after the termination of this period demonstrate the feasibility of the study design; patients undergoing behavioural therapy showed good compliance with few drop-outs and significantly higher rates of abstinence compared with supportive therapy. 60% of the patients suffer from a concomitant personality disorder (mostly of the dependent, insecure, and masochistic type). Nevertheless, statistically significant differences between the 2 behavioural therapy techniques could not be established; a positive correlation between personality disorders and relapse or attrition could be confirmed only for relapses occurring within the first 3 months of treatment.