Follow-up of 180 Alcoholic Patients for up to 7 Years After Outpatient Treatment: Impact of Alcohol Deterrents on Outcome

Authors

  • Henning Krampe,

    1. Department of Psychiatry and Psychotherapy, Georg-August-University, and Max-Planck-Institute of Experimental Medicine, Goettingen, Germany.
    Search for more papers by this author
  • Sabina Stawicki,

    1. Department of Psychiatry and Psychotherapy, Georg-August-University, and Max-Planck-Institute of Experimental Medicine, Goettingen, Germany.
    Search for more papers by this author
  • Thilo Wagner,

    1. Department of Psychiatry and Psychotherapy, Georg-August-University, and Max-Planck-Institute of Experimental Medicine, Goettingen, Germany.
    Search for more papers by this author
  • Claudia Bartels,

    1. Department of Psychiatry and Psychotherapy, Georg-August-University, and Max-Planck-Institute of Experimental Medicine, Goettingen, Germany.
    Search for more papers by this author
  • Carlotta Aust,

    1. Department of Psychiatry and Psychotherapy, Georg-August-University, and Max-Planck-Institute of Experimental Medicine, Goettingen, Germany.
    Search for more papers by this author
  • Eckart Rüther,

    1. Department of Psychiatry and Psychotherapy, Georg-August-University, and Max-Planck-Institute of Experimental Medicine, Goettingen, Germany.
    Search for more papers by this author
  • Wolfgang Poser,

    1. Department of Psychiatry and Psychotherapy, Georg-August-University, and Max-Planck-Institute of Experimental Medicine, Goettingen, Germany.
    Search for more papers by this author
  • Hannelore Ehrenreich

    1. Department of Psychiatry and Psychotherapy, Georg-August-University, and Max-Planck-Institute of Experimental Medicine, Goettingen, Germany.
    Search for more papers by this author

  • HK and SS have contributed equally to this work.Supported by a Grant from the German Ministry of Health.

Reprint requests: Hannelore Ehrenreich, MD, DVM, Max-Planck-Institute of Experimental Medicine Hermann-Rein-Str.3, 37075 Göttingen, Germany; Fax: +49 551 3899670; E-mail: ehrenreich@em.mpg.de

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.

Ancillary