National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan.
Division of Psychiatry, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Alcohol Clin Exp Res. 2021 Nov;45(11):2335-2346. doi: 10.1111/acer.14707. Epub 2021 Sep 29.
While accumulating evidence suggests a relation between the severity of alcohol dependence and the risk of its recurrence, the impact of dependence severity on the course of the disorder has not been carefully evaluated. The present study examined the impact of several severity indices of alcohol dependence on the drinking course after inpatient treatment.
This prospective study was conducted over a 12-month period following alcohol treatment at a specialized hospital. A total of 712 consecutively admitted alcohol-dependent patients were targeted for enrollment at the time of their hospitalization, with 637 patients registered and followed. The characteristics and severity of the subjects were assessed using multiple methods at admission, with their course after discharge followed continuously using mailed questionnaires that queried them regarding their drinking behavior.
Greater severity of dependence, assessed using the number of ICD-10 diagnostic criteria met, was associated with a lower rate of abstinence during the study period (p = 0.035). The rate of abstinence also decreased significantly as the baseline blood gamma-glutamyl transferase value and Alcohol Dependence Scale (ADS) score increased (p = 0.031 and p = 0.0002, respectively). In multivariate Cox proportional hazards analyses, the group with the most severe ADS scores had a significantly greater risk of relapse to drinking than the group with the least severe scores (HR = 2.67, p = 0.001). Dependence severity also associated with the drinking pattern; participants in both the controlled drinking group and the abstinence group had lower ADS scores at admission and a later age at first drinking (p = 0.001 and p < 0.001, respectively) than those with poorer drinking outcomes.
The present study showed that more severe alcohol dependence predicts a poorer course after alcohol treatment, as reflected by findings on multiple measures. These results suggest that assessing the dependence severity at the outset of treatment could be useful both in predicting treatment outcome and targeting interventions to alcohol-dependent individuals who need additional support in their recovery.
尽管越来越多的证据表明酒精依赖的严重程度与复发风险之间存在关联，但依赖严重程度对疾病过程的影响尚未得到仔细评估。本研究检查了几种酒精依赖严重程度指标对住院治疗后饮酒过程的影响。
这是一项在专门医院进行的为期 12 个月的前瞻性研究。在住院期间，共有 712 名连续入院的酒精依赖患者被纳入研究对象，其中 637 名患者登记并接受了随访。在入院时使用多种方法评估受试者的特征和严重程度，出院后通过邮寄问卷连续跟踪他们的饮酒行为。
使用符合 ICD-10 诊断标准的数量评估的依赖严重程度越高，研究期间的戒酒率越低（p=0.035）。随着基线血γ-谷氨酰转移酶值和酒精依赖量表（ADS）评分的升高，戒酒率显著下降（p=0.031 和 p=0.0002）。在多变量 Cox 比例风险分析中，ADS 评分最高的组与评分最低的组相比，复发饮酒的风险显著增加（HR=2.67，p=0.001）。依赖严重程度也与饮酒模式相关；在控制饮酒组和戒酒组中，参与者入院时 ADS 评分较低，首次饮酒年龄较晚（p=0.001 和 p<0.001），与较差的饮酒结果相关。
本研究表明，酒精依赖越严重，预示着酒精治疗后预后较差，这在多种指标上都有体现。这些结果表明，在治疗开始时评估依赖严重程度，既可以预测治疗结果，也可以针对需要额外支持以恢复的酒精依赖个体进行干预。
