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Follow‐up of 180 Alcoholic Patients for up to 7 Years After Outpatient Treatment: Impact of Alcohol Deterrents on Outcome
Author(s) -
Krampe Henning,
Stawicki Sabina,
Wagner Thilo,
Bartels Claudia,
Aust Carlotta,
Rüther Eckart,
Poser Wolfgang,
Ehrenreich Hannelore
Publication year - 2006
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/j.1530-0277.2006.00013.x
Subject(s) - abstinence , medicine , disulfiram , prospective cohort study , alcohol , alcohol dependence , psychiatry , biochemistry , chemistry , pharmacology
Objective: (1) To perform a 9‐year study of abstinence, lapse, and relapse in 180 chronic alcoholic patients, participants of the O utpatient L ongterm I ntensive T herapy for A lcoholics (OLITA); (2) To investigate the role of supervised alcohol deterrents (AD) in relapse prevention and as an adjunct for maintenance of long‐term abstinence. Method: This prospective open treatment study evaluates the long‐term course of drinking outcomes and AD use of 180 chronic alcoholics consecutively admitted from 1993 to 2002. Subsamples are compared for (1) sham‐AD versus verum‐AD (disulfiram/calcium carbimide), (2) coped lapses versus finally detrimental lapses versus malignant relapses, and (3) AD use for 13 to 20 versus >20 months. Results: In this 9‐year study, the cumulative probability of not having relapsed was 0.52, and that of not having consumed any alcohol was 0.26. Despite long‐term use, disulfiram/calcium carbimide was well tolerated. Patients on sham‐AD (due to contraindications to verum‐AD) showed higher cumulative abstinence probability than patients on verum ( S =0.86 vs. S =0.49, p =0.03). Detrimental lapses and malignant relapses occurred earlier than successfully coped lapses ( p <0.001); patients with detrimental lapse and with malignant relapse had fewer days of AD intake and less subsequent days without AD than patients with coped lapse ( p <0.001). The cumulative abstinence probability was S =0.75 for patients with long‐term intake compared with S =0.50 for patients who stopped AD between months 13 and 20 ( p <0.001). Conclusions: An abstinence rate of >50% in this 9‐year study strongly supports the concept of comprehensive, long‐term outpatient treatment of alcoholics. Supervised, guided intake of AD, also over extended periods, can be used as a predominantly psychologically acting ingredient of successful alcoholism therapy.