Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Subst Abuse Treat Prev Policy. 2020 Jan 2;15(1):1. doi: 10.1186/s13011-019-0249-7.
According to the German guidelines, people with severe alcohol use disorders (AUDs) should receive withdrawal treatment. Compared to somatic withdrawal treatment (SWT), extended duration and psychosocial elements of so-called "qualified withdrawal treatment" (QWT) aim to reduce relapse rates. Despite promising results of prospective studies on QWT, only few German inpatients seeking withdrawal treatment receive QWT. We estimated the potential effects on mortality and morbidity for higher proportions of treatment-seeking patients receiving QWT rather than SWT in the German city of Bremen.
In 2016 and 2017, 2051 inpatients were admitted to two specialised hospitals for withdrawal treatment. The potential beneficial effects of QWT over SWT were estimated by simulating treatment outcomes taken from two prospective studies. Outcomes comprised number and length of all-cause hospitalisations within 5 years, as well as abstinence and all-cause mortality rates within 28 months. Outcomes were estimated for actual and increased rates of QWT (25, 50%) among inpatients seeking alcohol treatment.
In the selected hospitals, 170 patients (8%) received QWT. If 25% of AUD inpatients were to receive QWT, benefits in abstinence rates (+ 18%), the total number of hospitalisations (- 9%) and hospital days (- 10%) could be expected. If 50% of AUD inpatients were to receive QWT, benefits in abstinence rates (+ 45%), the total number of hospitalisations (- 23%) and hospital days (- 26%) were more pronounced, in addition to reductions in mortality (- 20%).
Increasing the proportion of people with severe AUD enrolled in extended withdrawal treatment programs (such as QWT) may contribute to reduce overall alcohol-attributable burden of disease. Randomised controlled trials or other prospective studies controlling for confounding factors are needed to determine the potential at the population level.
根据德国指南，患有严重酒精使用障碍（AUD）的人应接受戒断治疗。与躯体戒断治疗（SWT）相比，所谓的“合格戒断治疗”（QWT）的延长持续时间和心理社会元素旨在降低复发率。尽管 QWT 的前瞻性研究结果令人鼓舞，但在寻求戒断治疗的德国住院患者中，只有少数人接受 QWT。我们估计，如果在德国不来梅市，更多接受 QWT 治疗的寻求治疗的患者比例高于 SWT，那么死亡率和发病率会有何变化。
2016 年和 2017 年，有 2051 名住院患者因戒断治疗而被收治到两家专门的医院。通过模拟两项前瞻性研究中的治疗结果，估计 QWT 对 SWT 的潜在有益效果。结果包括 5 年内所有原因住院的次数和时间，以及 28 个月内的戒酒和全因死亡率。结果是根据寻求酒精治疗的住院患者实际和增加的 QWT 率（25%、50%）来估计的。
在选定的医院中，有 170 名患者（8%）接受了 QWT。如果有 25%的 AUD 住院患者接受 QWT，可以预期戒酒率提高（+18%），住院总人数减少（-9%），住院天数减少（-10%）。如果有 50%的 AUD 住院患者接受 QWT，戒酒率提高（+45%），住院总人数减少（-23%），住院天数减少（-26%），死亡率降低（-20%）更为明显。
增加患有严重 AUD 的人群参加扩展戒断治疗项目（如 QWT）的比例，可能有助于降低与酒精相关的总体疾病负担。需要进行随机对照试验或其他前瞻性研究，以控制混杂因素，确定人群层面的潜在影响。
