Determinants of relapse and re-admission among alcohol abusers after intensive residential treatment

Archives of Public Health

EKM Broekaert¹  KAG Colpaert¹  WOI Vanderplasschen¹ 

[1]Ghent University, Department of Orthopedagogics, Ghent, Belgium

关键词: case management;    aftercare;    continuity of care;    recovery;    relapse;    treatment;    Alcohol abuse;   

Others  :  1083915
DOI  :  10.1186/0778-7367-67-4-194

【 摘 要 】

Little information is available in Belgium on the number and characteristics of alcohol abusers who contact treatment agencies and on the effectiveness of these services. International research has identified some determinants of relapse and recovery after treatment, but additional research is needed in order to better tailor services to the needs of service users.

This study aimed at measuring abstinence and relapse among alcohol abusers (n = 249) after intensive, residential treatment in specialized units in five Belgian psychiatric hospitals. Six month outcomes concerning substance use, psychological health, social support and integration were studied using the EuropASI. Logistic regression analyses were performed to identify predictors of relapse and readmission.

Significant reductions in the severity of alcohol and psychological problems were observed, but six months after the initial treatment episode more than half of all respondents (54%) had been using alcohol regularly. The domains 'psychiatric problems' and 'patients' personal perspectives' were the best predictors of relapse and readmission. Also, 'patients' living situations' predicted relapse. Specific variables that independently predicted relapse were 'satisfaction with day activities' and 'number of days with problems due to alcohol'. Less severe psychiatric problems at the start of treatment and more severe psychiatric problems and negative feelings of wellbeing at the time of follow-up were independent predictors of readmission.

We conclude that treatment agencies need to recognize the relapsing nature of alcohol abuse and have to organize their services from a continuing care perspective, including specific attention for individuals' psychological needs and day/leisure activities.

【 授权许可】

   
2010 Vanderplasschen et al.

【 参考文献 】

• [1]World Health Organisation (WHO): The World Health Report 2001: Mental health: new understanding, new hope. Paris, France: Sadag; 2001.
• [2]Grant BF, Dawson DA, Stinson FS, Chou SP, Dufour MC, Pickering RP: The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002. Drug Alcohol Depend 2004, 74(3):223-34.
• [3]Bayingana K, Demarest S, Gisle L, Hesse E, Miermans PJ, Tafforeau J, et al.: Gezondheidsenquête door middel van Interview, België, 2004. Brussel: Wetenschappelijk Instituut Volksgezondheid, Afdeling Epidemiologie; 2006.
• [4]Ewing JA: Detecting alcoholism - the CAGE questionnaire. J Am Med Assoc 1984, 252(14):1905-7.
• [5]Cattaert G, Pacolet J: Schatting van het alcoholgebruik / misbruik in Vlaanderen en België. Leuven: Hoger instituut voor Arbeid; 2002.
• [6]Dom G, De Groot F, Koeck A: Prevalentie van middelenproblemen en dubbeldiagnose in Belgische psychiatrische ziekenhuizen. Tijdschr Psychiatr 2004, 46(5):317-21.
• [7]De Donder E: Alcohol, illegale drugs, medicatie en gokken. Recente ontwikkelingen in Vlaanderen 2003-2004. Brussel: Vereniging voor Alcohol- en andere Drugproblemen (VAD); 2005.
• [8]Vanderplasschen W, De Bourdeaudhuij I, Van Oost P: Co-ordination and continuity of care in substance abuse treatment: an evaluation study in Belgium. Eur Addict Res 2002, 8(1):10-21.
• [9]De Donder E: Alcohol, illegale drugs & medicatie: recente ontwikkelingen in Vlaanderen 2001. Leuven: Acco; 2002.
• [10]Vandenbussche E: Vlaamse Registratie Middelenmisbruik (VRM): registratiegegevens 1999. Brussel: Vereniging voor Alcohol- en andere Drugproblemen (VAD); 2001.
• [11]Autrique M, Vanderplasschen W, Broekaert E, Sabbe B: Practitioners' attitudes concerning evidence-based guidelines in Belgian substance abuse treatment. Eur Addict Res 2009, 15(1):47-55.
• [12]Pelc I, Verbanck P, Lebon O, Gavrilovic M, Lion K, Lehert P: Efficacy and safety of acamprosate in the treatment of detoxified alcohol-dependent patients: A 90-day placebo-controlled dose-finding study. Br J Psychiatry 1997, 171:73-7.
• [13]Besson J, Aeby F, Kasas A, Lehert P, Potgieter A: Combined efficacy of acamprosate and disulfiram in the treatment of alcoholism: A controlled study. Alcohol Clin Exp Res 1998, 22(3):573-9.
• [14]Ansoms C, Deckers F, Lehert P, Pelc I, Potgieter A: An open study with acamprosate in Belgium and Luxemburg: Results on sociodemographics, supportive treatment and outcome. Eur Addict Res 2000, 6(3):132-40.
• [15]Pelc I, Ansoms C, Lehert P, Fischer F, Fuchs WJ, Landrom F, et al.: The European NEAT Program: An integrated approach using acamprosate and psychosocial support for the prevention of relapse in alcohol-dependent patients with a statistical modeling of therapy success prediction. Alcohol Clin Exp Res 2002, 26(10):1529-38.
• [16]Finney W, Hahn AC, Moos RH: The effectiveness of inpatient and outpatient treatment for alcohol abuse: The need to focus on mediators and moderators of setting effects. Addiction 1996, 91:1773-96.
• [17]Timko C, Moos RH, Finney JW, Lesar MD: Long-term outcomes of alcohol use disorders: Comparing untreated individuals with those in Alcoholic Anonymous and formal treatment. J Stud Alcohol 2000, 61:529-40.
• [18]Andréasson S, Öjehagen A: Psychosocial treatment for alcohol dependence. In Treating alcohol and drug abuse: an evidence based review. Edited by Berlund M, Thelander S, Jonsson E. Darmstadt: WILEY-VCH; 2003.
• [19]Weisner C, Matzger H, Kaskutas LA: How important is treatment? One year outcomes of treated and untreated alcohol-dependent individuals. Addiction 2003, 98:901-11.
• [20]Cross GM, Morgan CW, Mooney AJ, Martin CA, Rafter JA: Alcoholism Treatment: A ten-year follow-up study. Alcohol Clin Exp Res 1990, 14:169-73.
• [21]Ellis D, McClure J: In-patient treatment of alcohol problems: Predicting and preventing relapse. Alcohol Alcohol 1992, 27:449-56.
• [22]Neto D, Xavier M, Lucena P, Vieira da Silva A: An evaluation of the therapeutic programme conducted by the Southern Regional Alcohol-abuse Treatment Centre: Study on the programme's results one year after discharge from inpatient care. Eur Addict Res 2001, 7:61-8.
• [23]Doyle M, Carr A, Rowen S, Galvin P, Lyons S, Cooney G: Family-oriented treatment for people with alcohol problems in Ireland: A comparison of the effectiveness of residential and community-based programmes. J Fam Ther 2003, 25:15-40.
• [24]Van de Velde JC, Schaap GE, Land H: Follow-up at a Dutch addiction hospital and effectiveness of therapeutic community treatment. Subst Use Misuse 1998, 33:1611-27.
• [25]Booth PG, Dale B, Slade PD, Dewey ME: A follow-up study of problem drinkers offered a goal choice option. J Stud Alcohol 1992, 53:594-600.
• [26]Shaw GK, Waller S, McDougall S, MacGarvie J, Dunn G: Alcoholism: A follow-up study of participants in an alcohol treatment programme. Br J Psychiatry 1990, 157:190-6.
• [27]McKay JR: Effectiveness of continuing care interventions for substance abusers: implica-tions for the study of long-term treatment effects. Eval Rev 2001, 25:211-32.
• [28]NDARC (The National Drug and Alcohol Research Centre): The treatment of alcohol problems: a review of the evidence. Sydney: NDARC; 2003.
• [29]Long CG, Williams M, Hollin CR: Treating alcohol problems: A study of programme ef-fectiveness and cost-effectiveness according to length and delivery of treatment. Addiction 1998, 93:561-71.
• [30]Trent LK: Evaluation of a four- versus six-week length of stay in the Navy's alcohol treatment program. J Stud Alcohol 1998, 59:270-9.
• [31]Lash SJ, Stephens RS, Burden JL, Grambow SC, DeMarce JM, Jones ME, et al.: Contracting, prompting and reinforcing substance use disorder continuing care: a randomized clinical trial. Psychol Addict Behav 2007, 21(3):387-97.
• [32]Gossop M, Harris J, Best D, Man LH, Manning V, Marshall J, et al.: Is attendance at Alcoholic Anonymous meetings after inpatient treatment related to improved outcomes? A 6-month follow-up study. Alcohol Alcohol 2003, 38(5):421-6.
• [33]Moos RH, Moos BS: Help-seeking careers: connections between participation in professional treatment and Alcoholics Anonymous. J Subst Abuse Treat 2004, 26(3):167-73.
• [34]Bodin MC, Romelsjö A: Predictors of 2-year drinking outcomes in a Swedish treatment sample. Eur Addict Res 2007, 13:136-43.
• [35]Kelly JF, Magill M, Stout RL: How do people recover from alcohol dependence? A sys-tematic review of the research on mechanisms of behavior change in Alcoholics Anonymous. Addict Res Theory 2009, 17(3):236-59.
• [36]Feuerlein W, Kufner H: A prospective multicenter study of inpatient treatment. Eur Arch Psychiatry Clin Neurosci 1989, 239:144-57.
• [37]Monahan SC, Finney JW: Explaining abstinence rates following treatment for alcohol abuse: A quantitative synthesis of patient, research design and treatment effects. Addiction 1996, 91:786-805.
• [38]Allen J, Anton RF, Babor TF, Carbonari J, Carroll KM, Connors GJ, et al.: Project MATCH secondary a priori hypotheses. Addiction 1997, 92(12):1671-98.
• [39]Heather N, Copello A, Godfrey C, Orford J, Raistrick D, Russell I, et al.: UK Alcohol Treatment Trial: client-treatment matching effects. Addiction 2008, 103(2):228-38.
• [40]Saitz R, Palfai TP, Cheng DM, Horton NJ, Dukes K, Kraemer KL, et al.: Some medical inpatients with unhealthy alcohol use may benefit from brief intervention. J Stud Alcohol Drugs 2009, 70(3):426-35.
• [41]Rapp RC: Strengths-based case management: Enhancing treatment for persons with substance abuse problems In D Saleebey (Ed). In The strengths perspective in social work practice. 4th edition. Boston: Pearson Education; 2006:128-47.
• [42]Perney P, Rigole H, Blanc F: Alcohol dependence: Diagnosis and treatment. Rev Med Intern 2008, 29(4):297-304.
• [43]Soyez V, De Leon G, Rosseel Y, Broekaert E: The impact of a social network intervention on retention in Belgian therapeutic communities: a quasi experimental study. Addiction 2006, 101(7):1027-34.
• [44]Schneider KM, Kviz FJ, Isola ML, Filstead WJ: Evaluating multiple outcomes and gender differences in alcoholism treatment. Addict Behav 1995, 20(1):1-21.
• [45]Ritter A, Bowden S, Murray T, Ross P, Greeley J, Pead J: The influence of the therapeutic relationship in treatment for alcohol dependency. Drug Alcohol Rev 2002, 21(3):261-8.
• [46]Bottlender M, Soyka M: Outpatient alcoholism treatment: Predictors of outcome after 3 years. Drug Alcohol Depend 2005, 80(1):83-9.
• [47]Becker HC: Alcohol dependence, withdrawal, and relapse. Alcohol Res Health 2008, 31(4):348-61.
• [48]Vaughn T, Sarrazin MV, Saleh SS, Huber DL, Hall JA: Participation and retention in drug abuse treatment services research. J Subst Abuse Treat 2002, 23(4):387-97.
• [49]Williams M: The cry of pain: understanding suicide and self-harm. London: Penguin Books; 1997.
• [50]Schmidt P, Kufner H, Hasemann S, Loehnert B, Kolb W, Zemlin U, et al.: Is the European Addiction Severity Index a useful tool in the diagnostic routines of alcohol dependence? Fortschr Neurol Psychiatr 2007, 75(9):541-8.
• [51]Keymeulen R, Raes V: European Addiction Severity Index (EuropASI): Handleiding De Sleutel. Merelbeke: De Sleutel; 1999.
• [52]Broekaert E, Haack M, Kaplan C, Öberg D, Sallmén B, Segraeus V, et al.: The Biomed II IPTRP Project: Implementation of Diagnostic Instruments. Eur Addict Res 2002, 8:201-3.
• [53]Hendriks V, Kaplan CD, van Limbeek J, Geerlings P: The Addiction Severity Index: Reliability and validity in a Dutch addict population. J Subst Abuse Treat 1989, 6(2):133-41.
• [54]McLellan AT, Kushner H, Metzger D, Peters F, Smith I, Grissom G, et al.: The fifth edition of the Addiction Severity Index. J Subst Abuse Treat 1992, 9:199-213.
• [55]Gastfriend DR, Garbutt JC, Pettinati HM, Forman RF: Reduction in heavy drinking as a treatment outcome in alcohol dependence. J Subst Abuse Treat 2007, 33:71-80.
• [56]McLellan AT: Reducing heavy drinking: A public health strategy and a treatment goal? Commentary J Subst Abuse Treat 2007, 33:81-3.
• [57]Roets G, Kristiansen K, Van Hove G, Vanderplasschen W: Living through exposure to toxic psychiatric orthodoxies: exploring narratives of people with 'mental health problems' who are looking for employment on the open labour market. Disabil Soc 2008, 22(3):267-81.
• [58]Laudet AB: What does recovery mean to you? Lessons from the recovery experience for research and practice. J Subst abus Treat 2007, 33(3):243-56.
• [59]McLellan AT: Have we evaluated addiction treatment corretcly? Implications from a chronic care perspective. Addiction 2002, 97(3):249-52.
• [60]Orwin RG, Sonnefeld LJ, Garrison-Mogren R, Smith NG: Pitfalls in evaluating the effectiveness of case management programs for homeless persons: lessons from the NIAAA Community Demonstration Program. Eval Rev 1994, 18(2):153-207.
• [61]Tuten M, Jones HE, Lertch EW, Stitzer M: Aftercare plans of inpatients undergoing de-toxification. Am J Drug Alcohol Abuse 2007, 33(4):547-55.
• [62]Tims F, Leukefeld CG, Platt JJ: Relapse and Recovery in Addictions. New Haven: Yale University Press; 2001.
• [63]Witkiewitz K, Marlatt GA: Relapse prevention for alcohol and drug problems - That was Zen, this is Tao. Am Psychol 2004, 59(4):224-35.
• [64]Miller WR, Willbourne PL: Mesa Grande, a methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction 2002, 97:265-77.
• [65]Walton MA, Blow FC, Bingham CR, Chermack ST: Individual and social/environmental predictors of alcohol and drug use 2 years following substance abuse treatment. Addict Behav 2003, 28:627-42.
• [66]Colpaert K, Vanderplasschen W, Van Hal G, Broekaert E, Schuyten G: Dual substance abusers seeking treatment: Demographic, substance-related, and treatment utilization characteristics. J Drug Issues 2008, 38(2):559-83.
• [67]Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC: Lifetime co-occurence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the national comorbidity survey. Arch Gen Psychiatry 1997, 54(4):313-21.
• [68]Bryssinck D, Broekaert E, Vandevelde S: Psychosis and newly emerging dependency groups: The search for an adapted model of care at the Psychiatric Centres Sleidinge in Belgium. Ther Communities 2005, 26(2):150-62.
• [69]McKellar J, Ilgen M, Moos BS, Moos R: Predictors of changes in alcohol-related self-efficacy over 16 years. J Subst Abuse Treat 2008, 35(2):148-55.