A prospective multicentre study of in-patient treatment for alcoholics: 18- and 48-month follow-up (munich evaluation for alcoholism treatment, MEAT)

Abstract

In a prospective multicentre study of 1410 alcoholics (73% men) data were collected at five different times: admission, discharge, 6, 18 and 48 months after discharge. The details from the 21 treatment centres involved were acquired from staff-members; follow-up data on patients were collected by personal interviews and/or mailed questionnaires. In all, 85%, 84% and 81% of the patients could be traced, respectively. Additionally, data of patients' sick leave days and in-patient treatment were provided by the health insurance and pension insurance institutions, respectively. Outcome criteria were drinking behaviour, working and partner situation, and subjective complaints. The drinking behaviour was divided into three rough categories: abstinent, improved and unimproved. For 18 months 53% of the patients remained abstinent, 8.5% improved and 38% did not improve. For 48 months 46% remained abstinent, 12% improved and 42% did not improve. During the last 6 months prior to the 48-month data collection 66% were abstinent, 4% improved and 30% did not improve. Only 3% of patients succeeded in maintaining controlled drinking. The percentage of days of sick leave was reduced by 64% and of in-patient treatment from 34.7% to 14.6% during the 18-month period after discharge (in comparison with the 18-month period prior to treatment). Only 21% of the patients regularly attended self-help groups. Out of the patients' variables, ten for men and five for women could be identified as prognostically relevant. In the 48-month follow-up these factors were reconsidered. In men almost all, in women only three of the five factors were confirmed. The treatment variables were evaluated according to the prognosis factors (positive vs negative group). In the 48-month follow-up the treatment variables relevant in the 18-month follow-up were also reassessed. In the positive prognosis group five variables were confirmed, in the negative prognosis group only one. In addition, differentiated indication variables for the three treatment lengths were developed and applied to a model. The following appeared to be clues regarding the length of desirable treatment. For an unfavourable prognosis in both men and women no short-term treatment should be given; medium- or long-term treatment is to be preferred. For a medium prognosis men do better with short-term treatment; for women medium-treatment is preferred. For a favourable prognosis for men medium-term treatment should be avoided; long-term is preferred; for women short-term treatment may also be preferred.

Efficacy of an Intensive Outpatient Rehabilitation Program in Alcoholism: Predictors of Outcome 6 Months after Treatment

“…some previous studies handle improvers as abstinent), the present fi ndings clearly highlight the efficacy of the evaluated outpatient treatment program. Since the differences in outcome defi nitions limit the comparability of the fi ndings between different studies, we suggest the use of uniform study designs and defi nition of outcome criteria as proposed by Feuerlein and Küfner [2] to improve alcoholism research on a standardized and comparable basis.…”

“…Outcome description at the 6-month follow-up was based on the classifi cation proposed by Feuerlein and Küfner [2] . According to this classifi cation, patients were judged to be abstinent (no subjective reports or objective indications of alcohol consumption), improved (during the last 6 months no more than three drinking periods lasting for less than 1 week (lapses) or !…”

“…The effi cacy of this treatment has been addressed in a number of catamnestic studies which indicate a favorable ( 1 40%) abstinence rate in a 4-year follow-up (MEAT study [2] ). Nevertheless, with regard to the increasing costs in health service systems and the reduction of the number of inpatient treatment facilities, a need of alternative strategies as for example outpatient treatment emerges.…”

Prospektive Untersuchung zur Effizienz der ambulanten Entwöhnungstherapie bei alkoholabhängigen Patienten

“…Es wurden auch diejenigen Patienten katamnestisch nachuntersucht, die die Therapie nicht regulär beendet hatten. Als Grundlage zur Bewertung des Outcomes wurde die Klassifikation von Feuerlein und Küfner [9] verwendet. Danach wurden Patienten als abstinent gewertet, bei denen weder ein subjektiver Bericht noch ein objektiver Hinweis für Alkoholkonsum vorlag.…”

Germany, alcohol and alcohol policy: oscillating between contemplation, action and relapse

“…During the 1930s and 1940s, eugenic issues increasingly dominated alcohol research in Germany, and the scientific community contributed to the ideology and crime of national socialism (for additional details see Bühringer & Watzl 2003). The first major post-World War II alcohol research group was established by Feuerlein in approximately 1970 and published, among other topics, the following: (1) treatment and follow-up data and factors that moderated outcome from a large, multisite field study that included 21 centres and 1410 patients (Feuerlein & Küfner 1989) and (2) groups are investigating genetic differences in the sensitivity of the endogenous opioid system to alcohol (Rommelspacher et al 2001) and on the neuronal correlates of urges to drink (Heinz et al . 2005).…”