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Alcohol and Alcoholism Advance Access published online on October 13, 2008
Alcohol and Alcoholism, doi:10.1093/alcalc/agn075
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© The Author 2008. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved

Effectiveness of Sequential Combined Treatment in Comparison with Treatment as Usual in Preventing Relapse in Alcohol Dependence

Domingos Neto1,*, Rita Lambaz2, Pedro Aguiar3 and Jonathan Chick4

1 Princípio-Actividades Médicas, Rua Sargento José Paulo dos Santos No. 25, 1800-330 Lisboa, Portugal
2 Unidade de Alcoologia do IDT, Parque de Saúde de Lisboa, Av. do Brasil, 53 A. 1749-006 Lisboa, Portugal
3 Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, 1600-560 Lisboa, Portugal
4 University of Edinburgh, Department of Psychiatry, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK

* Corresponding author: Domingos Neto, at Princípio-Actividades Médicas, Rua Sargento José Paulo dos Santos No. 25, 1800-330 Lisboa, Portugal. Tel: +00-351-919-365-614; E-mail: dnetoster{at}gmail.com

Received 10 March 2008; first review notified 6 May 2008; in revised form 19 June 2008, 25 July 2008; accepted 31 July 2008


  Abstract

Aim: The aim of this study was to compare the effectiveness of the sequential combined treatment (SCT) and treatment as usual (TU) in relapse prevention in a sample of alcohol-dependent patients, during 180 days of outpatient treatment. Method: 209 alcohol-dependent patients who could attend with an informant adult were randomized to either TU or SCT. The primary outcome measure was time to first relapse, defined as the consumption of any amount of alcohol during the 180 days of follow-up. Secondary outcome measures included maximum duration of continuous abstinence (MDCA), cumulative abstinence duration (CAD), quality of life (ARPQ) and blood test markers of alcohol consumption. Results: The SCT approach was more effective than TU. The Kaplan–Meier abstinent proportion at the end of the 180 days was 78% for the SCT group and 59% for the TU group (P < 0.01). The mean time to first relapse was 150 days for SCT and 123 days for TU (P < 0.01). The relative risk reduction of relapse was 62% for SCT after adjustment in multiple Cox regression (P < 0.01). SCT had more MDCA (P < 0.05) and more CAD (P < 0.05). Therapy sessions lasted slightly longer for SCT than TU (mean 13 min versus 10 min). Conclusions: SCT can result in better outcomes than TU in the outpatient treatment of alcohol dependence.


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