Treatment for Alcohol Dependence in Catalonia: Health Outcomes and Stability of Drinking Patterns over 20 Years in 850 Patients

Alcohol Unit, Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clínic, IDIBAPS, Villarroel 170, 08036 Barcelona, Spain.
Alcohol and Alcoholism (Impact Factor: 2.89). 06/2009; 44(4):409-15. DOI: 10.1093/alcalc/agp032
Source: PubMed


The aim of this study was to evaluate long-term outcomes in alcohol-dependent patients following outpatient treatment and gender differences in drinking outcome and mortality.
A 20-year longitudinal prospective study was done with interim analyses at 1, 5 and 10 years. Of the original sample of 850 patients, 767 (90%) were located 20 years later and 393 of these were interviewed. 273 (32%) patients died during the intervening period and 101 (12%) no longer wished to participate in the study. Drinking status was assigned based on the 12 months prior to the follow-up interview.
At the 20-year follow-up, 277 (32.6%) of the 393 patients for whom drinking status could be assigned were abstinent (defined never drinking or drinking on less than occasion per month and never more than four drinks/drinking occasion.), 29 (3.4%) were controlled drinkers and 87 (10.2%) were heavy drinkers. Controlled drinking was the least stable category, with 23% continuing from year 5 to year 10 in that category, and 10% continuing in that category from year 10 to year 20. Mortality was higher (39.1%) in those who had been categorized at year 5 as heavy drinkers compared to those who had been categorized as controlled drinkers or abstinent. Abstinent patients reported fewer alcohol-related problems and better psychosocial functioning than heavy drinkers. Women achieved higher abstinence rates (47.2% versus 29.0%, P = 0.005) and had lower mortality (22.4% versus 34.5%, P = 0.03) than men.
Over the long-term, abstinence is the most frequent and stable drinking outcome achieved and is associated with fewer problems and better psychosocial functioning. Controlled drinking is rarely achieved and sustained. Women appear to do better than men in the long term.

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Available from: Antoni Gual, Jan 18, 2016
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    • "In our cohort, 15% of all deaths observed were due to external causes. These results are consistent with reports from other studies, in which accidental causes account for 8 to 18%, depending on geographical area and the pattern of consumption among individuals with AUD (Costello, 2006; Fudalej et al., 2010; Gual et al., 1999; Haver et al., 2009; Liskow et al., 2000; Mattisson et al., 2011; Noda et al., 2001; Rivas et al., 2013). "
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    ABSTRACT: Background The goal of this study was to estimate excess death due to external causes among 18- to 64-year-olds with alcohol use disorder (AUD) who were treated at public outpatient treatment centers, and the time elapsed from treatment initiation to death.Methods We conducted a retrospective longitudinal study among 7,012 outpatients aged 18 to 64 years who began treatment for AUD between 1997 and 2007. Deaths due to external causes (intentional and unintentional injuries) were monitored until the end of 2008. Person-years (PY) of follow-up and crude mortality rates (CMRs) were calculated for all study variables, for each sex, and for 2 age groups (18 to 34 and 35 to 64 years). Standardized mortality ratios (SMRs) were estimated by age group and sex. Survival was analyzed using the Kaplan–Meier method and Cox regression.ResultsWe recorded 114 deaths due to external causes. The CMR was 2.7 per 1,000 PY (95% confidence interval [CI]: 2.2 to 3.2), with significant gender differences only among younger individuals (CMR for males = 3.9 per 1,000 PY [95% CI: 2.2 to 5.5] and CMR for females = 2.8 per 1,000 PY [95% CI: 0.1 to 5.6]). Unintentional injury was the most common cause of death (n = 65), of which acute poisoning (n = 25; 38.5%) and traffic accidents (n = 15; 23.1%) were the most prevalent. Suicide accounted for 91.8% (n = 49) of deaths from intentional injuries. The excess of mortality between the AUD group and the general population (SMR) was 9.5 higher than in the general population (95% CI: 7.9 to 11.4), with significant differences between genders (SMR = 6.1 [95% CI: 4.9 to 7.5] in males and SMR = 20.4 [95% CI: 13.9 to 29.9] in females). Approximately 35% of deaths among individuals aged <35 years and 60% among women occurred within a year of initiating treatment.Conclusions This study highlights the importance of excess of mortality among people with AUD and patients' vulnerability during the initial years of treatment. Preventing premature deaths due to external causes among women and younger patients with AUD is a priority.
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    • "Our findings on the impact of AUDs on various domains of a person's life are consistent with studies from HIC (Gual et al., 2009; Room et al., 2005) and from India. In a qualitative study from West Bengal, India, heavy drinking was reported to result in disturbance of social peace through unruly behaviour. "
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    ABSTRACT: The explanatory models (EM) and coping strategies for mental health problems influence treatment seeking and the subsequent patient journey. The goal of this study was to explore the EMs and coping strategies for alcohol use disorders (AUD). We conducted semi structured interviews with 29 men with AUD and 10 significant others (SO) in two sites in India. Thematic analysis was used to analyse data. The former were predominantly married, literate and employed; the latter were predominantly wives, literate and employed. Alcohol consumption and AUDs are seen to be mainly associated with psychosocial stress, with other factors being peer influences, availability of disposable income and drinking for pleasure. They are perceived to result in a range of adverse impacts on social life, family life, personal health and family finances. Various coping strategies were deployed by men with AUD and their significant others, for example avoidance, substitution, distraction, religious activities, support from AA/friends/family, restricting means to buy alcohol and anger management. Reduction/cessation in drinking, improved family relationships, improved emotional/physical wellbeing and better occupational functioning were the most desired treatment outcomes. There are considerable similarities, as well as some key differences, observed between the EMs for AUD in India and those reported from other cultures which have implications for the global applicability and contextual adaptations of evidence based interventions for AUD.
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    • "For example, a 20-year cohort study of alcohol-dependent patients who had received treatment for their alcoholism found that some participants consumed large average amounts of alcohol over prolonged periods of time. During the times in the cohort study when participants were drinking, average alcohol consumption per day was approximately 140 grams per participant (for a description of the cohort and main results see [16,17]), thus making it probable that the heaviest drinkers consumed above 150 grams of pure alcohol during the biological latency period. "
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