Alcohol and Alcoholism Advance Access published online on May 21, 2007
Alcohol and Alcoholism, doi:10.1093/alcalc/agm038
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The Author 2007. Published by Oxford University Press on behalf of the Medical Council on Alcohol.
Prescription procedures in medication for relapse prevention after inpatient treatment for alcohol use disorders in Switzerland
University Hospital of Psychiatry Bern, Switzerland
* Author to whom correspondence should be addressed at: University Hospital of Psychiatry Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland. Tel: +41 (0)31 930 9111; Fax: +41 (0)31 930 9404; E-mail: moggi{at}puk.unibe.ch
Received 4 September 2006; first review notified 6 March 2007; in revised form 2 April 2007; accepted 13 April 2007
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Abstract |
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Aims: In randomized controlled trials with high internal validity, pharmacotherapy using acamprosate, naltrexone, and, to a somewhat lesser extent, disulfiram has proved effective in preventing relapse in patients with alcohol use disorders (AUD). There remains, however, a paucity of studies with sufficient external validity in which the effectiveness of pharmacotherapy in clinical practice is investigated. This study aimed to make a contribution to close this gap in research. Methods: In this naturalistic, prospective study, a comparison on indices of substance use, psychiatric symptoms, and treatment service utilization was carried out using samples of 92 patients who received pharmacotherapy and 323 patients who did not receive pharmacotherapy following discharge from 12 residential AUD programmes (index stay). Results: Patients that received pharmacotherapy were more likely to use alcohol during the index stay and at the 1-year follow-up. Moreover, this patient group more readily utilized treatment services during a 2-year period prior to and a 1-year period following index stay than patients who were not given pharmacotherapy. Nevertheless, when pharmacotherapy was prescribed before first post-treatment alcohol use, it was associated with delay of alcohol use, fewer relapses, and a redued need for inpatient teatment. In many cases, however, medication was not prescribed until alcohol use and relapse had occurred. The length of time to first alcohol use was longer, and the cumulative abstinence rate higher, for disulfiram than for acamprosate, the latter being generally prescribed for more severely alcohol-dependent patients. Conclusions: There is a need for further studies to probe the reasons why medication for relapse prevention is not prescribed upon discharge from residential treatment and for less severely alcohol-dependent patients.
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