Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome

Alcohol Clin Exp Res. 2006 Jan;30(1):86-95. doi: 10.1111/j.1530-0277.2006.00013.x.

Abstract

Objective: (1) To perform a 9-year study of abstinence, lapse, and relapse in 180 chronic alcoholic patients, participants of the Outpatient Longterm Intensive Therapy for Alcoholics (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.

Publication types

  • Comparative Study
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alcohol Deterrents / administration & dosage*
  • Alcoholism / rehabilitation*
  • Ambulatory Care*
  • Case-Control Studies
  • Combined Modality Therapy
  • Cyanamide / administration & dosage*
  • Disulfiram / administration & dosage*
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Germany
  • Humans
  • Long-Term Care
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Prospective Studies
  • Psychotherapy
  • Secondary Prevention
  • Substance Abuse Detection
  • Temperance

Substances

  • Alcohol Deterrents
  • Cyanamide
  • Disulfiram