Outcome variables in the evaluation of alcoholics' treatment: Lessons fromthe Italian Assessment of Alcoholism Treatment (ASSALT) project

The observational evaluation of alcoholics' treatments requires a combined analysis of alcoholic behaviour during treatment and of adherence to therap eutic programmes. The application of survival analysis techniques in this s etting has been explored in this study. Two hundred and seventy alcoholics admitted to 15 Italian treatment units in a I-year period were followed-up for 2 years, recording date and length of every recurrence episode and of d efinitive or transitory interruption of the planned treatment. An extensive use of several survival analysis techniques was made. The length of time b etween the start of the treatment and the first episode of relapse did not give a reliable measure of frequency of failures. Conversely, the length of time between the start of treatment and withdrawal appeared to be unbiased . The cumulative proportions of treatment-compliant patients (and the corre sponding 95% confidence intervals) were 71% (66-76%), 63% (57-69%) and 53% (47-60%) after 6 months, 1 year and 2 years respectively from the start of treatment. Cumulative abstinence duration before withdrawal was significant ly and positively associated with the risk of first, of definitive, and of every episode of treatment interruption. This first application of survival analysis techniques to the combined study of alcoholic behaviour and of ad herence to treatment can improve our knowledge of treatment evaluation. Our results suggest that compliance to treatment is an objective and versatile outcome measure. Long-term follow-up studies aimed to elucidate the determ inants of withdrawal should be performed.