Long term impact of treatment in alcoholics.: Results from a 10-year longitudinal follow-up study of 850 patients

BACKGROUND AND OBJECTIVE: Alcohol dependence syndrome is defined as a chronic disease. Nevertheless, few prospective studies have been conducted in order to assess the long term impact of treatment in the course of the disease. Moreover, those studies have not included,, drinkers from wine drinking cultures. This study was designed to assess prospectively the long term course of alcoholism and the impact of treatment on it, in a sample of Spanish drinkers. PATIENTS AND METHOD: 850 alcoholics aged 16 to 55 years who entered treatment during 19881989 in 8 specialized centres of the Catalan Drug Addiction Network were included in the study (75.6% of eligible patients). Patients had to meet DSM III criteria for alcohol dependence, a stable home address and a close relative willing to provide collateral information. Evaluation was carried out at 0, 1, 5 and 10 years. 15 and 20 years assessments are also planned. RESULTS: At 10 years of follow up, 131 (15.4%; 95% confidence interval [CI], 13-18) patients had died, 656 (77.2%; 95% CI, 75-80) were alive and 63 (7.4%; 95% CI, 5-9) could not be located. 54 patients (6.4%; 95% CI, 5-8) refused to be interviewed. Drinking patterns for the last 3 years was evaluated in 588 (70%; 95% CI, 67-73) patients: 311 (37%; 95% CI, 34-40) were abstinent, 58 (7%; 95% Cl, 5-9) were controlled drinkers and 219 (26%; 95% CI, were heavy drinkers. Abstinent patients had lower morbidity and casualties as well as a less tendency to use emergency room services. Also, abstinence was significantly related to lower levels of psychosocial stress and better global functioning, especially in the sociolaboral area. CONCLUSIONS: Our results challenge the popular belief that alcoholics are chronic relapsers. The changes induced by treatment appear to be long lasting, with better outcomes in the group of, abstinent patients. Even though treatment is effective for a high percentage of patients, mortality rates are 4 and 6 times higher than expected for men and women respectively.