Outcome of alcoholism treatment among 5578 patients in an urban comprehensive hospital-based program: application of...

The Elmhurst Alcoholism Program data system relates fraction of time patients are in remission to length of time they are know, and permits a systematic search for groups of variables which predict greater abstinence rates. Our program (inpatient detoxification ward, multidisciplinary outpatient clinic, and halfway house) sets abstinence as a goal. After initial data collection (social and demographic variables, income, education, residence, drinking and drug history, legal problems, and prior treatment), we collect data at 30 days after admission and at 2- or 3-month intervals thereafter from all patients who remain in contact. Forty-five percent of all patients are lost before 30 days. Only 32% of those still under observation at 1 yr and 27% of those still under observation at 2 yr claim continual abstinence. From among many combinations of variables examined for predictive power, a group of five was chosen as best. Patients who at their first follow-up interview reported attending AA meetings and taking Antabuse and who in addition had a job at admission, were older, and were admitted through the clinic rather than through inpatient detoxification had a greater fraction of time abstinent. Nevertheless, the best cluster of predictor variables did not account for more than 25% of the variation in rates of abstinence. Many social variables are not independent, and some may merely be indicators of duration or severity of alcoholism. Contemporary alcoholism treatment is, at best, of limited effectiveness.