Outcome good for patients with dual alcohol use and affective disorders

Jan 22 2014

By Lucy Piper, Senior medwireNews Reporter

Alcohol use disorders (AUDs) in patients with depression or bipolar disorder can be successfully treated with intervention and follow-up, say researchers.

They also found that achieving light levels of drinking early in recovery may be sufficient, with the “vast majority” of patients who achieved this 3 months after treatment remaining light drinkers or becoming abstinent within 5 years.

The researchers, led by Conor Farren (St Patrick’s University Hospital, Dublin, Ireland), say that reducing the number of drinking days or the number of drinks per drinking day may be a “realistic treatment strategy” that patients with comorbid AUDs and affective disorders may find easier to adhere to than abstinence.

The study involved 205 patients with bipolar disorder or depression and AUD who completed a treatment program involving detoxification and mood stabilization, 4 weeks of inpatient care, and 5 months of aftercare.

The retention rate at 5 years after treatment was 55.6% and at this point 51.8% of patients were abstinent. Also, the average number of drinking days in the past 3 months had fallen to 10.9, from 39.0 at baseline, and the units per drinking day had dropped from an average of 12.1 to 5.7.

Among the patients who were not abstinent 3 months after treatment, 93.8% were considered light drinkers, having reduced their mean alcohol intake from a heavy consumption of 39.6 units/week before treatment to just 5.2 units/week.

At 5 years, 53.6% of these patients were still light drinkers, 39.3% were abstinent, and just 7.1% were heavy drinkers.

The researchers found that patients who were abstinent at 2 years were more than four times as likely to be abstinent at 5 years, while the number of drinking days and number of drinks per drinking day at 6 months and 2 years predicted number of drinking days and number of drinks per drinking day at 5 years.

In addition to improving drinking outcomes, treatment reduced the intensity of depression, elation, and anxiety, but Farren and co-workers note that addiction outcomes seemed to predominate.

Writing in Alcoholism: Clinical and Experimental Research, they suggest that “a significant amount of the focus in the initial treatment of this dual diagnosis population should be upon the addictive component rather than the affective component, as this is what appears to drive long-term outcome in this group.”

They add that both bipolar disorder and depressed patients responded equally well to treatment and so could possibly be treated together in a single program.

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