Vollmer, H. C., Domma, J.

[Differences in the success rates of inpatient therapy for alcohol and illegal drug abusers. A Replication Study] [Article in French]

2020

L’Encéphale, 46 (2), 102-109. doi: 10.1016/j.encep.2019.09.008

Link to full text in French (with costs), "Différence de réussite au traitement hospitalier entre dépendants à l’alcool et dépendants aux drogues illicites: une étude de reproductibilité": https://www.em-consulte.com/article/1359023/alertePM

Introduction: Irrespective of the type of psychotherapy used, the abstinence-oriented treatment of drug abusers is less successful than that for alcohol abusers. If, on the other hand, the two groups are parallelized in such a way that the patients are identical with respect to the five characteristics of gender, age, schooling, work situation and partner situation, then there is no difference between the success rates of the drug and alcohol abusers. The aim of this study is to determine whether this result can be replicated in another therapeutic institution.

Method: Retrospective field study of 320 abusers of illegal drugs and 320 alcohol abusers who were treated with behaviour therapy. By combining the binary characteristics gender, work situation and age, the drug-dependent patients were divided into 23=8 groups, and the same number of alcohol abusers were randomly selected for each group. The scheduled period of inpatient treatment was 90 days for the alcohol abusers and 120 days for the drug abusers. Every week the patients had one session of individual psychotherapy and four to five group therapy sessions. According to the indications, the certified behaviour therapists implemented the following interventions including behaviour analysis, relapse prevention, cognitive therapy, self-management and behavioural family therapy. Comparison of the success rates was carried out using the Chi2 test, and changes in the psychological findings were tested with one-way variance analysis.

Results: There was no difference between drug and alcohol abusers with respect to the rate of therapy termination according to plan (around 80%). A total of 48% of the drug abusers and 41 % of the alcohol abusers who could be followed up had been continuously abstinent at the one-year catamnesis without a single relapse. There were also no differences between the two groups when it was assumed that the patients who could not be followed up had relapsed. In the case of both the drug and alcohol abusers the abstinence rate was highest in over-29-year-old employed men (57.6%; 48.4%). The abstinence rate was lowest in employed female drug abusers (27.8%) and young, unemployed female drug abusers (0%, n=11).

Discussion: What appears to influence the abstinence rate after inpatient treatment is not only the type of substance consumed but also sociodemographic characteristics. In addition to individually tailored therapy, our results confirm the importance of a highly differentiated presentation of the outcomes of therapy in the specialist literature. An average rate of abstinence (e.g. 30%) is insufficient to evaluate an intervention unless information is also provided about the patients for which the intervention is suitable and those for which it is not. In accordance with the Reproducibility Project, we consider replication studies essential in psychotherapy, even though in practice the considerable methodical requirements can only be partially fulfilled.

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