Psychiatric co-morbidity and aftercare among alcoholics: a prospective study of a nationwide representative sample

Aims. To study prospectively the type and extent of aftercare sought by patients following their admission for alcohol and other substance abuse treatment as a function of psychiatric co-morbidity. Design. Prospective cohort study with follow-up after 16 months. Setting and participants. A nationwide sample of alcoholics discharged from inpatient treatment (N = 351) in Iceland. Measurements. The Diagnostic Interview Schedule was used to assign psychiatric diagnoses at the time of index admission. A questionnaire on the type and number of aftercare attendances was mailed to all participants to obtain information about aftercare. Findings. A combination of attendance at Alcoholics Anonymous (AA) and professional care was the most common aftercare (49%); while only 8% received no aftercare whatsoever. The mean number of AA attendances was over 24 while it was less than 3 for the various professional appointments. Patients with a diagnosis of schizophrenia had a lower rate of attendance at AA. Other types of co-morbidity did not affect AA attendance but did increase rates of professional help-seeking. Conclusions. Better professional treatment attendance might be gained by integrating AA concepts while AA might benefit from professional input to address the prevalent co-morbid psychiatric disorders.