Longterm follow-up of 180 chronic alcoholics during and after comprehensive integrated outpatient treatment: Relation of deterrent medication (DM) and outcome

Objectives: (1) To perform 9-year follow-up of abstinence, lapse and relapse in 180 chronic alcoholics, participants of OLITA (Outpatient Longterm Intensive Therapy for Alcoholics); (2) To investigate the role of supervised DM intake in relapse prevention and as an adjunct for maintenance of longterm abstinence.

Methods: This prospective open treatment study evaluates longterm course of drinking outcomes and DM use of 180 chronic alcoholics consecutively admitted between 1993 and 2002. Subsamples are compared regarding (1) sham-DM vs. verum-DM (disulfiram/calcium carbimide), (2) coped lapses vs. finally detrimental lapses versus malignant relapses, (3) DM use for 13–20 months vs. DM use for >20 months.

Results: During 9-year follow-up, cumulative probability of not having relapsed was .52. Despite longterm use, disulfiram/calcium carbimide were well tolerated. Patients on sham-DM showed higher cumulative abstinence probability than patients on verum (S=.86 versus S=.49, p=.03). Patients with coped lapse had more days of DM intake and more subsequent days without DM than patients with detrimental lapse and with malignant relapse (p<.001). Cumulative abstinence probability was S=.75 for patients with longterm intake compared to S=.50 for patients who stopped DM between months 13 and 20 (p<.001).

Conclusions: Supervised, guided intake of DM, also over extended periods, can be employed as a predominantly psychologically acting ingredient of successful alcoholism therapy.