Konsequenzen von Rückfall und Behandlungsabbruch im stationären Drogenentzug: eine 1-Monats-Katamnese

Abstract

The success of inpatient drug detoxification is often measured by the number of addicts fully completing treatment. Indeed, treatment adherence is one of the most important predictors of the long-term course of addictive disorders. However, less is known about the consequences of relapse during drug-detoxification treatment and the relationship of relapse to premature treatment drop-out. The following questions were addressed in this study: What is the frequency of premature drop-out and relapse in an inpatient drug detoxification programme? How often does relapse during detoxification result in premature termination of treatment? What are the consequences of relapse and drop-out on substance use and social integration of the patients one month after treatment? Data of 104 inpatients (24 women, 80 men) having undergone voluntary detoxification treatment at the Psychiatric University Hospital of Zurich between 1995 and 1996 were analysed. Most patients fulfilled the criteria of multiple drug use including opiates according to ICD-10. Almost two thirds (63%) of inpatients completed detoxification treatment successfully, 18% were abstinent from any substance use one month after treatment. Almost every second inpatient (45%) lapsed or relapsed, i.e. used substances during detoxification. Substance use during treatment was significantly related to drop-out: a majority of patients (81%) without lapse completed the detoxification successfully, but less than half of patients (41%) with lapse did so. The higher rate of drop-out of lapsers was, mainly due to premature exclusion from the programme. Results indicate that lapse during treatment is not generally related to negative outcome, rather its consequences depend on the kind of treatment termination: thus, not any patient prematurely discharged from treatment achieved abstinence one month after leaving the hospital. However, patients who had completed detoxification achieved abstinence even when they had lapsed during treatment. Furthermore, premature exclusion has also negative consequences on referral to further treatment and the housing situation of addict patients. Consequently, lapses during detoxification treatment should not necessarily lead to premature discharge. Instead, patients should have the chance to work through the experience of lapse within a qualified treatment setting.