Therapeutic and psychosocial interventions in the treatment of alcohol-dependent patients : findings from clinical research

Abstract

Alcoholism is a chronic and severe disease that impairs life-quality and causes problems in health, in psychological, and in social issues over time. In the past very few treatment services were available for alcoholism. Nowadays, since alcohol dependence is defined as a psychiatric disease treatment offers have augmented. Despite multiple treatment facilities abstinence rates or successful long term treatment outcomes are still modest. This raises the question if treatment methods can be improved by adapting or tailoring treatments more to patients’ individual need, like in personalized medicine, where patients’ individual characteristics provoke different treatment implications. Alcoholism is a disease heterogeneous in appearance and in its consequences. Thus reasons for alcohol drinking, the expected effects of alcohol and the course of drinking patterns are very different among alcohol dependents. Therefore it seems clear that there cannot be a standardized, uniform treatment for alcoholism which is adequate for everyone. Personalized treatments for alcoholism including different aspects with different implications for treatment are needed. Hence, the present cumulative dissertation consists of three publications from clinical research addressing different aspects in the treatment of alcoholism, which play an important role and have impact on treatment outcomes as well as on future research. In the first article the feasibility and effectiveness of a voluntary smoking cessation offer was investigated parallel to an alcohol detoxification treatment. Outcomes in smoking quit rates were modest, but a clear advantage in the reduction rate of cigarettes was found in the CBT condition. Furthermore, it was found that the sub-group of heavy smokers benefited the most of the CBT intervention. The second article investigated the impact of self-help group attendance, namely 12-step programs predominantly Alcoholics Anonymous on relapse rates. There was only a slightly better outcome for patients attending a 12-step group involvement regularly as an aftercare group exclusively in the first month after treatment discharge. In the third article self-perceived interpersonal problems were examined finding that alcohol-dependent patients exhibited a higher burden of interpersonal problems in general compared to healthy controls. Furthermore, alcohol-dependent women exhibited in total more and different dimensions of interpersonal problems compared to alcohol-dependent men. All these results from clinical research may help to adapt treatments in a way, so that patients benefit more. A higher attraction of the treatment may lead to a higher participation and probably to a higher compliance. Findings may help to improve quality of therapies, best in the sense of a personalized treatment, which in turn may improve outcomes.