Predictive factors for relapse after an integrated inpatient treatment programme for unipolar depressed and bipolar alcoholics.
OBJECTIVE
The aim of this study was to examine prospectively examined predictors of relapse in alcohol dependence with comorbid affective disorder.


METHODS
One hundred and eighty-three unipolar depressed or bipolar alcoholics who completed an integrated inpatient treatment programme for dual diagnosis were assessed at baseline, post-treatment discharge and at 3 and 6 months post treatment. Backwards stepwise likelihood ratio multiple logistic regression was used to investigate the impact of multiple covariates on relapse to alcohol in the 0-3- and 3-6-month period post discharge.


RESULTS
The retention rate at 3 months post discharge was 95.3% (177 patients) and at 6 months it was 87.4% (162 patients). Higher level of anxiety at baseline and discharge was significantly associated with relapse at 3, but not at 6 months, in all subjects. Higher baseline alcohol use disorder identification test scores were associated with relapse at 3 and at 6 months. Intention and planning to attend aftercare after discharge from the hospital were associated with non-relapse at 3 and 6 months, respectively. Levels of depression, of elation and of craving at baseline were not significantly predictive of relapse. Those who had relapsed at 3 months were significantly more likely to remain drinking at 6 months. Rehospitalization within the first 3 months post discharge appeared to be protective against further relapse.


CONCLUSIONS
Baseline patient factors, including levels of anxiety, appear to play a significant role in relapse to alcohol in this difficult to treat population.
Farren
Conor K
CK
Department of Psychiatry, St. Patrick’s Hospital and Trinity College Dublin, James Street, Dublin 8, Ireland. cfarren@stpatsmail.com
McElroy
Sharon
S
D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000517:prevention & control* / Q000523:psychology*; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D055502:Secondary Prevention; D016320:Substance Abuse Treatment Centers; D016896:Treatment Outcome