Predicting an effective treatment for alcohol dependent patients

Abstract

Aims

To ascertain factors associated with adherence and relapse among alcohol dependents.

Methods

Three hundred alcoholic patients were interviewed at hospitalization and again 3 and 6 months thereafter. Assessment included the SCID-I to check for the presence of Axis I mental disorders, a questionnaire focusing on patient relationship with AA groups, and specific questions about participation in psychotherapy. A logistic regression analysis was performed to determine predictive variables for relapse and adherence.

Results

Previous treatment for alcohol dependence (OR=3.65; CI:1.77-7.05) and being single (OR=2.39; CI:1.06-5.42) proved to be associated with relapse, whereas adherence to AA mutual-help groups (OR=0.31; CI:0.15-0.66), presence of a co-morbid depressive disorder (OR=0.46; CI:0.23-0.92), and probably adherence to psychotherapy (OR=0.52; CI:0.26-1.04) could be associated with abstinence. Higher educational level was predictive of adherence to AA (OR = 2.19; IC 1.08-4.41). Besides higher educational background (OR = 3.60; CI 1.6-7.9), the presence of a co-morbid depressive disorder (OR = 3.47; CI 1.8-6.5), the use of other drugs together with alcohol (OR = 3.08; CI 1.5-6.19), and having been previously treated (OR = 2.87; CI 1.29-6.40) were related to adherence to psychotherapy. The presence of a substance-induced anxiety disorder emerged as a factor of non-adherence to psychotherapy (OR = 0.27; CI 0.63-0.003).

Conclusion

These findings reinforce the importance of psychotherapy and AA groups as strategies for alcoholics to remain abstinent for longer periods. The identification of predictors of adherence and relapse are important to guide clinicians in the choice of the treatment strategies more likely to be successful.