Factors Affecting Remission and Relapse in Alcohol Dependence can they Really be Predicted?

Abstract

Objectives: This prospective and retrospective study of 154 patients with alcohol use disorders was done with an intent to assess various factors affecting remission and relapse. 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 subgroups of patients. Methods: Patients with ethanol-related liver disease 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. Semistructured clinical interviews, the Symptom Checklist 90–Revised (SCL90-R), Addiction Severity Index (ASI), and the Beck Depression Inventory (BDI) were recorded. 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. Results: A majority of the sample, 71 percent (n = 110), had significant psychiatric symptoms at intake: 20 percent (N = 22) presented with depressive symptoms, 13 percent (N = 14) with anxiety symptoms, and 42 percent (N = 46) with combined depressive and anxiety symptoms. Thirty-five percent of patients who presented with combined depression and anxiety symptoms were abstinent at six months. These patients had worse prognosis than the less symptomatic cohort at intake, including those who presented with depression symptoms alone; in the latter group, 70 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. Conclusions: Concurrent depression or anxiety symptoms, low education, and lack of motivation for abstinence had a significant negative predictive effect on treatment outcome. Higher relapse rate was seen in concomitant opioid dependence, high risk’ situations, and previous relapses. Positive predictors were more number of coping strategies, principally adaptive ones.