Determinants of Treatment Outcome, Follow-Up, and Abstinence Rates Among Patients With Alcohol Use Disorder: A Prospective Study

Abstract

BackgroundThe treatment of alcohol use problems needs to have a multidimensional approach for early recovery and better outcome. ObjectiveThe study aimed to study the socio-demographic, clinical, and psychological factors associated with the three-month clinical outcomes among patients with alcohol use disorder treated in a tertiary care general hospital psychiatric unit in southern India. MethodsThis is a prospective three-month follow-up study. Patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria for alcohol use disorder were selected for the study. The baseline severity of alcohol use was assessed by the Severity of Alcohol Dependence Questionnaire, alcohol craving by Alcohol Craving Questionnaire (ACQ), impulsivity by Barratt Impulsiveness Scale, anxiety and depression by Hospital Anxiety and Depression Scale and personality traits by Personality inventory for DSM-5. Craving was assessed at 2, 4, 8 and 12 weeks post-discharge. ResultsA total of 110 patients participated in the study. After 3 months of follow-up, 75.5% of the patients remained abstinent throughout the follow-up period. The sample was divided into two groups based on the abstinent status at 12 weeks. Both the abstinent and relapsed users were compared based on socio-demographic, marital, family, illness-related, alcohol-usage, and psychological characteristics, the baseline and follow-up craving indices. There were no statistically significant differences between the two groups based on sociodemographic characteristics. Compared to the relapsed group, the abstinent individuals displayed increased adherence to follow-up visits and attended more frequent individual therapy sessions, however, there were no significant differences between the two groups in the number of group therapy sessions attended. Also, the abstinent group demonstrated lower subjective craving at both the baseline and during follow-up. The relapsed users had reported a significantly greater proportion of history of suicide in the family. Further correlational analyses were done to find the direction of associations between psychological characteristics and alcohol-usage characteristics. High attentional impulsivity and motor impulsivity were associated with early age of first use. High attentional impulsivity, motor impulsivity and impulsive planning were associated with early age of dependence. Early age of dependence was associated with increased levels of antagonism and psychoticism. Younger onset of alcohol use was associated with increased levels of craving at baseline. The baseline alcohol use severity and the baseline craving towards alcohol were positively correlated with follow-up craving indices as per ACQ and craving index (CI) scales. ConclusionThe patients who were abstinent displayed reduced subjective craving towards alcohol at baseline and were more adherent in attending individual and group therapy sessions. Among the relapsed users, most relapsed before four weeks and had a family history of alcohol dependence, family...

Alcohol use disorder research in India: An update

“…Alcohol-related factors like age of onset of dependence, current age of seeking treatment, severity of dependence, and family history of alcohol dependence determine the treatment outcomes. [ 212 213 214 215 216 217 218 219 ] At an individual level, temperamental factors like extraversion, coping styles, factors like exposure to relapse cues, craving, locus of control (external), mood states, and anger are common reasons for relapse. [ 97 220 221 222 223 224 225 226 ] A few studies explored the role of biological markers (leptin, ghrelin) as predictors of relapse.…”