Alcohol Abstinence and Relapse in ALD Patients, Predicting the Unpredictable

Abstract

1. Abstract <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.1. <span style=font-size:10.0pt;font-family: times= new= roman,serif=>Objectives: <span style=font-size:10.0pt; font-family: times= new= roman,serif=> Alcoholism is a chronic relapsing disorder. Alcoholism is common, and continues to be the source of great cost to afflicted individuals, their families and the community at large. Alcohol dependence is characterized by a prolonged course of alcohol-related problems and a persistent vulnerability to relapse. Even though there is an improvement in multiple domains of life after alcohol treatment, the risk of relapse remains high following treatment. This prospective and retrospective study of 451 patients with alcohol use disorders was done with an intent to assess various factors affecting remission and relapse and improve outcome for individuals with alcohol dependence. Demographic variables, clinical parameters and certain psychosocial factors were evaluated. Early identification of risk factors may help us in defining a more rigorous follow up protocol in these sub group of patients. 1.2. Methods: Patients with ethanol related liver disease and alcohol dependence were enrolled after their presentation in gastroenterology clinic and followed thereafter at 1, 3, 6, and 12 months. Initial assessments included USG abdomen LFT RFT, UGI Endoscopy and other relevant investigations. Semi structured clinical interviews, the Symptom Checklist 90-Revised (SCL90-R), Addiction Severity Index (ASI), the Beck Depression Inventory (BDI) were recorded. <span style=font-size:10.0pt; font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=> High-Risk Alcoholism Relapse Scale based score was calculated.2 Patients were reassessed at six and twelve months to determine treatment outcome (abstinence status and duration of continuous abstinence). Data were coded, validated and analyzed using descriptive statistics. 1.3. Results: A majority of the sample 70 percent (n=315) had significant psychiatric symptoms at intake: 22 percent (N=70) presented with depressive symptoms, 17 percent (N=15) with anxiety symptoms, and 41 percent (N=192) with combined depressive and anxiety symptoms. Fourty percent of patients who presented with combined depression and anxiety symptoms were abstinent at six months. These patients had worse prognosis than less symptomatic cohort at intake, including those who presented with depression symptoms alone; in the latter group, 60 percent were abstinent at six months. Key predictor variables included days in treatment, primary drug of abuse, frequency of drug use, and report of concurrent depression or anxiety symptoms at intake. <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.4. <span style=font-size:10.0pt;font-family: times= new= roman,serif=>Conclusions: <span style=font-size:10.0pt; font-family: times= new= roman,serif=> Concurrent depression or anxiety symptoms low education, lack of motivation for abstinence had a significant negative predictive effect on treatment outcome. Craving was noted as most common cause for relapse in alcohol dependent patients. Higher relapse rate was seen in concomitant opioid dependence, high risk’ situations, previous relapses Positive predictors were more number of coping strategies, principally adaptive ones. There is significant association between age at first drink, age at dependence, duration of dependence, other Co-morbid diagnosis of patients and relapse. Early consideration of these risk factors and more rigorous follow up can help in reducing incidence of relapses.