A Randomised Clinical Trial of In-Patient versus Combined Day Hospital Treatment of Alcoholism: Primary and Secondary Outcome Measures

Abstract

In Germany, the treatment system for alcoholics is predominantly in-patient (IP) oriented, but no randomised trials of setting effects have been conducted until now. We examined if detoxification treatment offered in a day clinic setting would lead to results comparable to the usual IP treatment. After initial IP detoxification, patients (n = 109) at a standard withdrawal treatment unit were randomly assigned to IP or day hospital groups. In both settings, identical psychosocial treatment was given. In this article, results of primary (percent days abstinent and drinks per drinking day) and secondary outcome measures (relapses during treatment, premature termination, additional hospitalisation during follow-up, percent of voluntary abstinent days and continuous abstinence) are reported. Outcome measures were assessed quarterly during a 1-year follow-up period. Patients improved significantly after both treatments, but we found no significant setting or setting × time interaction effects for any primary or secondary outcome measure.

Substance Abuse Intensive Outpatient Programs: Assessing the Evidence

“…Multiple randomized clinical trials and quasi-experimental studies have been conducted on IOPs that were designed to treat substance use disorders. We identified five studies based on four randomized trials that compared intensive outpatient or day treatment services with inpatient or residential treatment (4–8) and two studies of inpatient treatment versus IOPs that included both randomized study participants and individuals who refused randomization (9,10). Our search also revealed six naturalistic analyses of patients treated in inpatient and intensive outpatient settings (11–16) and one qualitative review of research published after 1995 (17).…”

“…Alcohol dependence (7,8,13,17) and cocaine dependence (4,14) were the primary diagnoses of participants in studies of intensive outpatient services. Two randomized trials (5,18) and four naturalistic analyses (11,12,15,16) included people with alcohol and drug (undefined) diagnoses.…”

Häufigkeit und Kosten zusätzlicher stationärer Behandlungen im Jahr nach tagesklinischer oder vollstationärer Alkoholentzugsbehandlung

“…Die Methodik dieser Studie und Ergeb− nisse bezüglich des Konsumverhaltens wurden an anderer Stelle ausführlich dargestellt [2]. Im Bezug auf die Reduktion des Alkoholkonsums im Jahr nach der Therapie (durchgängige Abstinenz, Prozentsatz abstinenter Tage und Trinkmenge an Trinktagen im Katamnesezeitraum) hatten sich keine signifikanten Unterschiede zwischen ta− gesklinischem und vollstationärem Behand− lungssetting gezeigt [2]. Im Jahr nach den Be− handlungen erfolgte eine deutliche Reduktion der Trinkmenge an Trinktagen von durchschnitt− lich 170 ml reinem Alkohol auf 96 ml und eine Zunahme abstinenter Tage …”

“…Die Qualität der tageskli− nischen Behandlung ist hinsichtlich der Reduktion des Alkohol− konsums der vollstationären Variante ebenbürtig[2]. Die vorlie− gende Untersuchung zeigt nun, dass der Kostenvorteil nicht durch häufigere zusätzliche stationäre Behandlungen und da− durch entstandene höhere direkte Kosten oder durch eine Re− duktion erwünschter rehabilitativer Maßnahmen (Entwöh− nungsbehandlungen) neutralisiert wurde.…”

Reducing Dropout among Traumatized Alcohol Patients in Detoxification Treatment: A Pilot Intervention Study

“…Studies have clearly shown the superiority of qualified detoxification treatment over its purely somatic type [5,7] . In recent years, day clinic and out-patient models of qualified detoxification treatment have been emerging, showing effects at least as good as the in-patient programs [8,9] .…”