Alcoholism prognosis statistics Alcoholism prognosis scale Chronic alcoholism prognosis Neuropathy alcoholism prognosis Bipolar alcoholism prognosis Alcoholism recovery prognosis Peripheral neuropathy alcoholism prognosis End stage alcoholism prognosis Li. Two-year prognosis after residential treatment for patients with alcohol dependence: three chief guidelines for sobriety in Japan

Introduction

Alcohol dependence, which is characterized by “loss of control”, is a chronic relapsing disorder similar to diabetes or hypertension. 1 It has a considerable component of genetic susceptibility and is also influenced by environmental factors. 2 Therefore, long-term maintenance therapy is very important. We should recognize redrinking by alcoholics as a symptom such as relapse in cancer or re-injury of a joint sprain. In addition, we have to take into account not only the abstinence from alcohol but also the recovery of quality of life. The prognosis of alcoholism is more influenced by social–psychological factors of the patient than by therapeutic interventions. 3 The first study 4 about the prognosis of alcoholism in Japan found that a good prognosis was related more strongly to social factors than physical factors. In particular, the continuation of therapy was strongly related to a good prognosis. However, there are only a few studies in Japan on the factors associated with a good prognosis. Alcoholism prognosis.

The three chief traditional guidelines for sobriety (3CGS) in Japan are regular medical checkups, participation in self-help groups, and therapy with antidipsotropics. 5 3CGS have been extensively used in the treatment of alcohol dependence in Japan.

However, the official record of the origins of 3CGS is not clear. Prospective evidence to support these guidelines has been obtained abroad, but they have not been extensively studied in Japan.

With regard to the first guideline, alcoholics tend to discontinue attending medical checkups. Baekeland and Lundwall 6 reported that 57%–75% of outpatients dropped out before the fourth consultation. In addition, Scivoletto et al 7 reported that a half or more number of patients stopped attending consultations within several months, and only 16% continued attending checkup sessions for 1 year after the first consultation. On the other hand, continuing to attend medical checkups is strongly related to a good prognosis. 8

Similarly, in Japan, more than half of the patients with alcoholism stopped attending medical checkups within 6 months, and only 21.1% of patients were seen 1 year after their first consultation. 9 Japanese patients with alcoholism who continued therapy had a significantly higher rate of abstinence after 1 year, indicating that continued attendance of checkup sessions is strongly related to abstinence. 4

Many studies support the usefulness of the second guideline, participation in self-help groups. For example, the rate of abstinence of those who participate in alcoholics anonymous (AA) is approximately twice that of those who do not participate in any self-help group. 10 In Japan, research has supported the usefulness of Dansyukai (a traditional Japanese self-help group). Suzuki 3 reported that membership in Dansyukai had a significant impact on treatment outcome. In addition, Nishikawa 11 reported that continued participation in self-help groups is related to a significantly higher rate of continuing to attend checkup sessions.

The effectiveness of abstinence with using antidipsotropics has not been evaluated via double-blind, randomized controlled trials in Japan. In a questionnaire study 12 in Japan, 86% of specialists responded that antidipsotropics should be taken for <1 year. However, research on the ideal duration of antidipsotropic usage is lacking. According to Japanese guidelines for the treatment of alcoholism and related disorders, 13 “psychotherapy is more important than the effects of antidipsotropics, and there are many differences in the efficacy of antidipsotropics between facilities and researchers”. However, no mention is made of a recommended period of antidipsotropic usage. In addition, naltrexone, nalmefene, and acamprosate were not registered in Japan during the research period. Many reports support the effectiveness of disulfiram 14 – 20 and cyanamide, 21 but compliance to the administration regimen is also important. 22 Diehl et al 16 reported that disulfiram is more effective than acamprosate, particularly in patients with a long duration of alcohol dependence, and Berglund 14 reported evidence from a meta-analysis of a possible additive effect for naltrexone as well as for aversive treatment (disulfiram) in alcohol dependence.

Alcoholism prognosis statistics Alcoholism prognosis scale Chronic alcoholism prognosis Neuropathy alcoholism prognosis Bipolar alcoholism prognosis Alcoholism recovery prognosis Peripheral neuropathy alcoholism prognosis End stage alcoholism prognosis Li

The aim of the current study was to assess 3CGS by an examination of the prognosis of patients with alcohol dependence 2 years after their discharge from a residential treatment program.

Subjects and methods

Assessment of outcome

At baseline, we obtained information on age, sex, family medical history, educational level, age at first drink, age at onset of alcoholism, duration of drinking habit, first time in residential treatment or not, and cross-addictions. In addition, mean corpuscular volume as well as blood levels of aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase was measured (carbohydrate-deficient transferrin was not registered in Japan). Participants were also tested for brain atrophy. Computed tomography scans were assessed by a trained psychiatrist and radiologist, and we recognized “positive brain atrophy” only if the opinions of both experts matched. Table 3 shows information about the participants upon admission to the study.

Before participants were discharged from residential treatment, we asked about their intentions to participate in self-help groups and checked whether they were taking antidipsotropics.

The criterion for continuation of medical checkup is at least once within a month. Two years after discharge, we investigated the relationship between 3CGS compliance and abstinence rates as the primary outcome. In addition, we examined the following as secondary outcomes: the time to first drink after discharge, whether participants were readmitted to residential treatment, the number of days to readmission, the number of heavy drinking days, self-assessed health maintenance, employment status, social participation (voluntary participation and contribution to the community through attendance at school, self-help group, and vocational aid center; volunteer activity), and recovery that is defined in detail in the following sections. There is a custom of checking about heavy drinking as an indicator of the severity of redrinking in Japan. Outcomes were evaluated by psychiatrist by asking face-to-face. Participants were interviewed by telephone 2 years after discharge even if they had stopped attending checkup sessions.

We trusted the patients’ self-reports for the number of days to redrinking corroborated, if possible and with patients’ permission, with information about drinking from families and medical attendants. The degree of abstinence was divided into two categories: “perfect abstinence”, which was defined as no drinking of alcohol, and “partial abstinence”, which was defined as drinking several times but not drinking continuously during the 2 years since discharge. We utilized the definition of the Ministry of Health, Labour, and Welfare in Japan 25 of “heavy drinking” as drinking >60 g of alcohol per day.

Recovery was evaluated by the Japanese version of the Self-Identified Stage of Recovery, Part A (SISR-A). 26 A patient was defined as having achieved “SISR-A recovery” if he/she had reached the rebuilding or growth stages of recovery. A second measure of recovery (Criteria of Recovery from Alcohol and Drug Dependence in Japan, CRADJ) utilized the criteria from a previous study 27 and from the Betty Ford Institute Consensus Panel, 28 which defined recovery as “a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship”. We used the Betty Ford Institute’s criteria of sobriety and personal health, but we expanded their definition of citizenship from voluntary contributions to the community through working and school attendance to include also the participation in self-help groups or vocational aid center and other volunteer activities. In brief, we judged a patient to have achieved CRADJ recovery if he/she exhibited sobriety (perfect abstinence or partial abstinence), personal health, and citizenship.

Alcoholism prognosis statistics Alcoholism prognosis scale Chronic alcoholism prognosis Neuropathy alcoholism prognosis Bipolar alcoholism prognosis Alcoholism recovery prognosis Peripheral neuropathy alcoholism prognosis End stage alcoholism prognosis Li

Participation in self-help groups was also divided into two categories: “frequent participation”, in which the participant attended most meetings, and “partial participation”, in which the participant attended at least half of the meetings. Only patients in the “frequent participation” category could be said to meet the criteria of 3CGS. Participants were defined as attending regular medical checkups only if they had been attending continuously for 2 years. Finally, we analyzed the relationship between prognosis and each guideline of 3CGS.

The ethics committee of the Mental Care Center, Prefecture of Mie, approved this study, and all subjects provided written consent.

Results

The perfect abstinence rate 2 years after discharge was 36.7% (36 of 98 participants). The perfect and partial abstinence rates for the patients who followed all the principles of 3CGS were significantly higher than those for patients who did not follow any of the three guidelines (P<0.05 and P<0.01, respectively). However, only six patients followed the 3CGS perfectly.

In the logistic regression analyses between perfect abstinence rate and each guideline, perfect abstinence rate was statistically associated with regular medical checkups (AOR =5.33, 95% confidence interval =1.35–21.0) and participation to self-help group (AOR =3.79, 95% confidence interval =1.17–12.3).

Table 4 shows the attendance of medical checkups and prognosis. The perfect and partial abstinence rates, and some indicators, for patients who had attended checkup sessions were significantly higher than those for patients who had discontinued attendance. In addition, patients who had been regularly attending medical checkups were rehospitalized significantly more number of times.

Table 5 shows the participation in self-help groups and prognosis. The partial abstinence rates for patients who participated in self-help groups were significantly higher than those for patients who did not participate.

Alcoholism prognosis statistics Alcoholism prognosis scale Chronic alcoholism prognosis Neuropathy alcoholism prognosis Bipolar alcoholism prognosis Alcoholism recovery prognosis Peripheral neuropathy alcoholism prognosis End stage alcoholism prognosis Li

Table 6 shows the use of antidipsotropics (28 had taken disulfiram and two had taken cyanamide) after discharge and prognosis. The perfect and partial abstinence and regular attendance of checkup sessions for patients who had been taking antidipsotropics were significantly higher than those for patients who had not been taking antidipsotropics. We did not receive any reports of severe side effects from the use of antidipsotropics for 2 years.

For patients who were administered antidipsotropics before discharge, the rates of perfect and partial abstinence, regular attendance of checkup sessions, partial participation in self-help groups were significantly higher than those for patients who were not administered antidipsotropics before discharge ( Table 2 ).

The perfect abstinence rates for patients who had continued regular medical checkups (P<0.001) and who were taking antidipsotropics (P

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