General description of the cohort at inclusion
Socio-demographic, clinical and biological data for the participants at inclusion are summarized in Table
1.
Table 1
Characteristics of the population at inclusion
Age (years) | 45.2 ± 10.2 |
Sex-ratio (male/female) | 3.6 (258/72) |
Single/divorced/widowed (324) | 69.1 % (224) |
Lifestyle (324) |
Couple | 31.5 % (102) |
Living alone | 39.1 % (127) |
Other (family, friends…) | 29.4 % (97) |
With a professional activity | 55.4 % (174) |
Resources (327) |
Own or from family | 67.9 (222) |
Social | 32.1 (105) |
Smokers | 80.2 % (186) |
With psychiatric co-morbidity | 60.9 % (200) |
Type of psychiatric comorbidity |
None | 39.1 % (129) |
Dementia | 1.5 % (5) |
Psychosis | 4.6 % (15) |
Mood and affective disorder | 30.6 % (101) |
Anxiety disorder | 5.5 % (18) |
Personality disorder | 26.1 % (87) |
With somatic comorbidity | 7.6 % (25) |
Global Assessment of Functioning | 49.14 ± 15.60 |
AUDIT (312) | 26.9 ± 7.7 |
Risk use (score ≤7) | 2.2 (7) |
Harmful use (7< score <13) | 2.2 (7) |
Dependence (score ≥13) | 95.5 (298) |
BDI score (308) | 13.5 ± 7.1 |
BDI categories |
Absent | 5.8 (18) |
Slight | 16.2 (50) |
Moderate | 41.6 (128) |
Severe | 36.4 (112) |
MCV (µm3) | 97.9 ± 6.2 |
% >normal values (n) | 55.9 (181) |
SGOT (UI/L) | 47.4 ± 53.5 |
% >normal values (n) | 39.3 (129) |
SGPT (UI/L) | 42.5 ± 41.5 |
% >normal values (n) | 41.5 (136) |
GGT (UI/L) (mean ± SD) | 222.7 ± 408.2 |
% >normal values (n) | 61.6 (202) |
Current psychotropic treatment |
Neuroleptics | 14.2 % (47) |
Atypical antipsychotics | 14.5 % (48) |
Thymoregulators | 7.8 % (26) |
Antidepressants | 52.7 % (174) |
Anxiolytics | 90 (297) |
Benzodiazepines | 88.4 % (292) |
Related to benzodiazepines | 23.0 % (76) |
The study population consisted largely of young men, mostly living alone (69.1 %). About one-third of the participants declared living with someone else as a couple. Just over half the participants were employed, and most of their income came from private sources rather than from benefits.
In terms of addictive comorbid conditions, smoking was highly prevalent. In contrast, few subjects were dependent on another psychoactive substance: 2.5 % were dependent on cannabis, 0.8 % on opiates and 0.4 % on cocaine.
In terms of psychiatric comorbid conditions, depression was the most frequent comorbid condition (p < 0.001), followed by psychotic and anxious disorders.
According to the AUDIT scores, seven had a score of 7 or below. Clinical examinations confirmed alcohol dependence in these 14 cases. Mean daily consumption (TAC) was high, 34.6 % (108 people) of the participants declared consuming at least 10 units per day and 51.6 % (161 people) 5–8 units per day. Similarly, the number of heavy drinking days corresponded to “almost every day” for 51 % of the participants (159 people). The mean BDI score indicated moderate to severe depressiveness for this population, with a total proportion of 78 % of those included presenting a high score for depression.
Only a few somatic comorbid conditions were reported: ankylosing spondylitis (3 cases), esophagus, stomach and duodenum diseases (4), respiratory diseases (5), liver disease (1), viral infections (3), heart disease (3), metabolic disorders (2), epilepsy (2), breast cancer (1) and other physically disabling conditions (4 cases).
The values for biological markers of liver function and alcohol dependence (γGT and MCV) were both above the normal range (reference values) for 42 % of the participants (136 people). The values for these two markers were in the normal range for 24.7 % of the participants (80 people).
Regarding drug therapy, the most frequently prescribed drug at inclusion was benzodiazepine, followed by antidepressants, which were taken by more than half the participants.
Changes over the 24 months following the request for help to stop drinking and abstinence
Data were collected for about half the patients at the M6, M12 and M18 visits (Table
2).
Table 2
Quantitative and qualitative variables collected at 6 (M6), 12 (M12), 18 (M18) and 24 (M24) months after alcohol withdrawal
With any data | 51.8 | 171 | 38.6 | 146 | 42.7 | 141 | 51.8 | 249 |
With data to assess abstinence | 27.6 | 91 | 33.9 | 112 | 33.9 | 112 | 75.5 | 171 |
Abstinent | 57.1 | 52 | 40.2 | 45 | 46.4 | 52 | 41.4 | 103 |
Reasons for the absence of follow-up |
No data—lost | 47.8 | 76 | 62.4 | 118 | 38.8 | 128 | 13.3 | 13 |
Impossible to come | 24.8 | 82 | 34.4 | 65 | 15.2 | 50 | 19.4 | 64 |
Death | 0.03 | 1 | 3.2 | 6 | 7.3 | 14 | 21.4 | 21 |
With a psychiatric comorbidity | 56.7 | 97 | 63.7 | 93 | 42.5 | 77 | 48.2 | 120 |
Type of psychiatric comorbidity | | | | | 37.7 | | | |
None | 29.9 | 29 | 42.0 | 39 | 5.19 | 29 | 46.7 | 50 |
Dementia | 0 | 0 | 0 | 0 | 15.5 | 4 | 0 | 0 |
Psychosis | 9.3 | 9 | 18.2 | 17 | 20.7 | 12 | 14.9 | 16 |
Mood disorder | 37.1 | 36 | 20.4 | 19 | 3.9 | 16 | 13.1 | 14 |
Anxiety disorder | 9.3 | 9 | 3.2 | 3 | 24.7 | 3 | 1.9 | 2 |
Personality disorder | 21 | 18 | 20.4 | 19 | | 19 | 15.9 | 17 |
With somatic comorbidity | 11.3 | 11 | 6.5 | 6 | 5.2 | 4 | 5.6 | 6 |
Global Assessment of Functioning | 59.9 ± 19.7 | 70 | 56.7 ± 20.1 | 66 | 59.7 ± 20.6 | 63 | 58.2 ± 19.3 | 88 |
AUDIT score | – | | 14.5 ± 12.2 | 130 | – | | 14.0 ± 12.1 | 162 |
Risk use (score ≤7) | – | | 36.2 | 45 | – | | 40.1 | 65 |
Harmful use (7 < score <13) | – | | 13.1 | 17 | – | | 6.2 | 10 |
Dependence (score ≥13) | – | | 50.8 | 66 | – | | 50.6 | 82 |
BDI | 8.3 ± 7.3 | 163 | 7.8 ± 7.5 | 133 | 7.2 ± 7.1 | 130 | 7.7 ± 7.3 | 168 |
Absent | 29.5 | 48 | 39.1 | 52 | 36.9 | 48 | 40.2 | 68 |
Slight | 25.8 | 42 | 15.8 | 21 | 24.6 | 32 | 20.1 | 34 |
Moderate | 28.8 | 47 | 30.1 | 40 | 25.4 | 33 | 21.3 | 36 |
Severe | 15.9 | 26 | 15.0 | 20 | 13.1 | 17 | 18.3 | 31 |
MCV (UI/L) | 94.9 ± 6.0 | 175 | 95.4 ± 5.9 | 140 | 94.4 ± 5.9 | 141 | 94.3 ± 6.2 | 169 |
% >normal values (n) | 34.9 | 61 | 40 | 56 | 30.5 | 43 | 34.3 | 58 |
TGO (UI/L) | – | | – | | – | | 39.0 ± 55.3 | |
% >normal values (n) | | | | | | | 24.6 | 41 |
TGP (UI/L) | – | | – | | – | | 38.8 ± 61.9 | |
% >normal values (n) | | | | | | | 29.9 | 50 |
GGT (UI/L) | 94.9 ± 6.0 | 175 | 108.0 ± 269.3 | 143 | 112.9 ± 290.8 | 140 | 156.0 ± 379.9 | 168 |
% >normal values (n) | 43.4 | 76 | 40.6 | 58 | 41.4 | 58 | 18.8 | 82 |
Current psychotropic treatment | | | | | | | | |
Neuroleptics | 15.3 | 27 | 13.3 | 20 | 18.0 | 27 | 15.0 | 36 |
Atypical antipsychotics | 25.0 | 44 | 24.6 | 37 | 24.0 | 36 | 23.0 | 55 |
Thymoregulators | 13.6 | 24 | 12.0 | 18 | 12.0 | 18 | 11.3 | 27 |
Antidepressants | 63.0) | 111 | 65.3 | 98 | 62.6 | 94 | 51.8 | 124 |
Anxiolytics | 67.0 | 118 | 65.3 | 98 | 61.3 | 92 | 57.3 | 137 |
Benzodiazepines | 56.2 | 99 | 56.0 | 84 | 11.5 | 38 | 48.9 | 116 |
Related to benzodiazepines | 22.1 | 39 | 17.3 | 26 | 25.1 | 83 | 18.1 | 43 |
However, data were obtained for a larger proportion of the patients at M24, presumably due to the greater effort made to contact participants and, if the participants themselves could not be contacted, their families. The availability of biological data, and thus knowledge about abstinence, was more limited as it was restricted to patients we were able to trace.
The differences between the population at inclusion and the population at M24 correspond to the difference in the proportion of subjects living alone (35.2 % at M0 and 37.7 % at M24, p < 0.001), being single/widowed or divorced (34.5 % at M0 versus 31.3 % at M24; p < 0.001), having a professional activity (57.6 % at M0 and 41.2 % at M24, p < 0.001) and being on benefits (71.4 % at M0 versus 60.1 % at M24, p < 0.001). Neither age (45.2 ± 10.2 years versus 45.6 ± 10.2 years, p = 0.12) nor sex (78.7 % men at M24 versus 78.2 % at M0, p = 0.681) differed between M0 and M24.
A large number of subjects (21) died during the 24 months of the study.
Overall, the abstinent individuals did not follow a linear trajectory between M0 and M24. Data for all the follow-up visits were available for 87 people, 58 of whom (66.7 %) displayed intermittent abstinence. Only 23 % (20 participants) were entirely abstinent during the entire period from M0 to M24. Clinical data, but without biological data, were obtained for 281 participants; 24.6 % (69 participants) declared a total absence of alcohol consumption over the entire 24-month follow-up, whereas 61.5 % reported intermittent alcohol consumption.
The number of subjects remaining abstinent varied according to the criteria: clinical or biological. An analysis of the coherence of the two definitions of abstinence yielded a kappa value of 0.2307, with a 95 % confidence interval of 0.08–0.38. These values indicate poor concordance between the two measures.
We considered all records of diagnoses of comorbid conditions at any time point during the care of the subject within the 24 months following alcohol withdrawal. Mood disorders were the most frequently reported. The type and nature of the psychiatric co-morbidities reported at M24 differed from those at M0 (p < 0.001) with significantly less subjects with mood disorders or anxiety disorders, but an equivalent proportion of psychotic disorders, suggesting that this category benefits from better insertion in the care system.
Few somatic comorbid conditions were reported during the follow-up. At the various follow-up visits, we recorded all diagnoses for diverse conditions requiring treatment and causing some disability (e.g., lower back pain) (n = 5), episodic conditions (2), viral infections including hepatitis (9), lung and ear diseases (2), metabolic problems (obesity) (1) and cirrhosis (1). The proportion of somatic conditions reported between M0 and M24 did not differ (p = 0.516).
The mean scores for the psychometric scales indicated an improvement in the general state of the participants from M6 onward. At each follow-up visit, we observed an improvement in GAF score (p < 0.01), a significant decrease in depression score (p < 0.001) and a significant decrease in alcohol dependence (AUDIT score; p < 0.001) with respect to the values obtained at M0. The values obtained at the various follow-up visits (M6, M12, M18 and M24) did not differ for the population as a whole. In addition, the mean values of the biological markers used (γGT and MCV) returned to normal during the follow-up, whereas they were outside this range at M0.
Before requesting assistance to stop drinking, the participants had been hospitalized more than four times on average (Table
3). Only 39 % (129 participants) were admitted to a psychiatric unit for the first time when they requested assistance to stop drinking. Similarly, the mean duration of psychiatric care before the request for assistance was relatively short, although 19 % of the patients had been receiving care for over 10 years.
Table 3
Psychiatric care before inclusion to the study (before alcohol withdrawal) and during the 24 months after alcohol withdrawal (between M0 and M24) (n = 330) [(mean ± SD or % (n)]
Before alcohol withdrawal |
Number of psychiatric hospitalizations | 4.4 ± 8.3 |
Duration of psychiatric care (years) | 4.5 ± 7.1 |
Between M0 and M24 |
Cumulative number of days of complete hospitalization | 79.8 ± 130 |
Cumulative number of days of psychiatric home care | 52.4 ± 71.9 |
Rehospitalization | 56.2 % (164) |
Number of days between withdrawal and first psychiatric care | 146.4 ± 162.8 |
Home visits | 1.5 ± 8.4 |
Almost half the participants were readmitted in the 24 months following withdrawal, whereas a quarter only had outpatient follow-up (23.6 %). Patients returned to the care system relatively rapidly, with rehospitalization or the first care intervention within the first 6 months after weaning off alcohol. A total absence of care in the 24 months after weaning off alcohol was observed for only 7 % of the participants (Table
3).
We further studied the psychiatric comorbid conditions and characteristics according to care data. Patients with psychiatric comorbid conditions attended more follow-up visits for this study than patients without such comorbid conditions. For example, 51.4 % (90 participants) of subjects with comorbid conditions attended at least three follow-up visits, in comparison with only 32.3 % (50 participants) of those without comorbid conditions (p = 0.011). The first care intervention was between M0 and M6 for 70.9 % (124 participants) of subjects with comorbid conditions, but only 62.6 % without comorbid conditions (p < 0.001). A total absence of treatment was observed for only 13.1 % (23 participants) of subjects with comorbid conditions and 25.8 % (40 participants) with no psychiatric comorbid condition.
We looked for an association between socio-demographic variables (age, sex, source of income, living alone) or care received during the 24-month follow-up (hospitalizations, outpatient care) with abstinence status at M24.
Following the univariate analysis of the study population, the five variables retained for the multivariate logistic regression were care category (p = 0.199), age (p = 0.015), sex (p = 0.033), living alone (p = 0.146) and private income (p = 0.118).
In the multivariate logistic model, age and sex were significantly associated with abstinence at 24 months, as older age was associated with a higher likelihood of abstinence at 24 months. Participants aged over 60 years were therefore six times more likely to be abstinent at the end of the 24-month follow-up than participants under the age of 30 years. Women were twice as likely as men to be abstinent after the 24-month follow-up (Table
4). At the end of the manual stepwise descending procedure for logistic regression, only age was still included in the adjusted model.
Table 4
Odds ratios (OR) unadjusted and adjusted (logistic regression) for the association of age and gender to abstinence at 24 months after alcohol withdrawal
Ambulatory care | 0.93 | 0.36 | 2.42 | | | |
Hospitalization | 0.58 | 0.25 | 1.37 | | | |
Age <60 | 2.10 | 0.66 | 6.66 | 2.10 | 0.66 | 6.66 |
Age >60 | 7.58 | 1.74 | 33.09 | 7.58 | 1.74 | 33.09 |
Gender female/male | 1.98 | 1.06 | 3.70 | | | |
Living alone | 0.67 | 0.39 | 1.15 | | | |
Own resources | 1.59 | 0.89 | 2.84 | | | |