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


METHODS
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.
Krampe
Henning
H
Department of Psychiatry and Psychotherapy, Georg-August-University, and Max-Planck-Institute of Experimental Medicine, Goettingen, Germany.
Stawicki
Sabina
S
Wagner
Thilo
T
Bartels
Claudia
C
Aust
Carlotta
C
Rüther
Eckart
E
Poser
Wolfgang
W
Ehrenreich
Hannelore
H
D000328:Adult; D000427:Alcohol Deterrents / Q000008:administration & dosage*; D000437:Alcoholism / Q000534:rehabilitation*; D000553:Ambulatory Care; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D003484:Cyanamide / Q000008:administration & dosage*; D004221:Disulfiram / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D011613:Psychotherapy; D055502:Secondary Prevention; D015813:Substance Abuse Detection; D013695:Temperance
D000427:Alcohol Deterrents; D003484:Cyanamide; D004221:Disulfiram