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Alcohol and Alcoholism Vol. 34, No. 6, pp. 873-881, 1999
© 1999 Medical Council on Alcoholism

OUTCOME VARIABLES IN THE EVALUATION OF ALCOHOLICS' TREATMENT: LESSONS FROM THE ITALIAN ASSESSMENT OF ALCOHOLISM TREATMENT (ASSALT) PROJECT

Giovanni Corrao*, Vincenzo Bagnardi, Antonella Zambon, Sarino Aricò1, Claudia Dall'Aglio2, Giovanni Addolorato3, Ines Giorgi4 and the ASSALT group,{dagger}

Chair of Medical Statistics and Epidemiology, Department of Statistics, University of Milan,
1 Division of Gastroenterology, Unit of Alcohology, Mauriziano Umberto I Hospital, Turin,
2 Division of Internal Medicine, Unit of Alcohology, Saint Orsola Hospital, Bologna,
3 Department of Internal Medicine, School of Medicine, Catholic University, Rome and
4 Service of Psychology, Salvatore Maugeri Foundation, Pavia, Italy

Received 30 October 1998; first review notified 8 March 1999; accepted 4 May 1999

The observational evaluation of alcoholics' treatments requires a combined analysis of alcoholic behaviour during treatment and of adherence to therapeutic programmes. The application of survival analysis techniques in this setting has been explored in this study. Two hundred and seventy alcoholics admitted to 15 Italian treatment units in a 1-year period were followed-up for 2 years, recording date and length of every recurrence episode and of definitive or transitory interruption of the planned treatment. An extensive use of several survival analysis techniques was made. The length of time between the start of the treatment and the first episode of relapse did not give a reliable measure of frequency of failures. Conversely, the length of time between the start of treatment and withdrawal appeared to be unbiased. The cumulative proportions of treatment-compliant patients (and the corresponding 95% confidence intervals) were 71% (66–76%), 63% (57–69%) and 53% (47–60%) after 6 months, 1 year and 2 years respectively from the start of treatment. Cumulative abstinence duration before withdrawal was significantly and positively associated with the risk of first, of definitive, and of every episode of treatment interruption. This first application of survival analysis techniques to the combined study of alcoholic behaviour and of adherence to treatment can improve our knowledge of treatment evaluation. Our results suggest that compliance to treatment is an objective and versatile outcome measure. Long-term follow-up studies aimed to elucidate the determinants of withdrawal should be performed.


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