Before-discharge intervention method in the treatment of alcohol dependence

Background: Alcoholics have the fundamental problem of denying dependence o n alcohol and minimizing their alcohol-related problems. Therapeutic interv entions often fail to help alcoholics become aware of their drinking proble m and remain in long-range treatment programs, which is a prerequisite for recovery from alcohol dependence. Methods: Inpatients were assigned to either group 1 or 2 depending on which day of the week they were admitted to the hospital. A newly developed stru ctured intervention method (Before-Discharge Intervention Method, or BDIM) was employed with select (nonrandomized) hospitalized alcoholics in group 1 and their family members before the patients were discharged from the hosp ital. None of the patients in group 2 received the BDIM. With this interven tion method, the alcoholic's family members delivered to him or her verbal messages that conveyed concern about the alcoholic's problem drinking, thei r observations of the alcoholic's past episodes of drinking problems, and w ishes and support for abstinence. Unless patients died during hospitalizati on or would not be able to attend the hospital follow-up clinic and local s elf-help groups (Danshukai) after discharge, outcome evaluations were carri ed out on all patients in groups 1 and 2 during two calendar months, 3 mont hs after the last BDIM patient left the hospital. Outcome measures included patient's and family members' attendance at hospital outpatient follow-up sessions and self-help group meetings, and patient's abstinence. Results: Family members' attendance at hospital follow-up sessions and/or s elf-help group meetings was significantly higher in group 1 than in group 2 . Among the three subgroups of discharged patients in either group 1 or 2-t hat is, those who lived with their spouse, those who lived with someone oth er than their spouse, and those who lived alone- only those in group 1 who lived with their spouse did significantly better than their counterparts in group 2 in three treatment outcome measures. However, patients' maintenanc e of abstinence was significantly better only when they and their family me mbers both attended hospital outpatient follow-up sessions and/or self-help group meetings. We noted no other statistically significant difference bet ween groups 1 and 2 in any of the other two subgroups of discharged or pati ents in any of the three treatment outcome variables. Irrespective of the B DIM, patients who lived alone did significantly more poorly than either tho se who lived with their spouse or those who lived with someone other than t heir spouse in terms of attendance at hospital follow-up sessions and local self-help group meetings and abstinence. Conclusions: This intervention method can help the alcoholic face the reali ty of his or her drinking problems and alcohol dependence and thus remain l onger in long-range rehabilitation programs, which is a prerequisite for su ccessful recovery from alcohol dependence.