Impact of brief relapse prevention intervention in patients with alcohol dependence

Abstract

Alcoholism accounts for 4% of deaths worldwide and 4.5% of global burden of disease and injury (WHO, 2011). In Zambia 15.6% of the population drink alcohol of which 43.7% consume alcohol heavily (Acuda et al, 2011). Relapse prevention interventions are used worldwide as an essential part of the treatments of patients with alcohol dependence. There is evidence that family member’s involvement in relapse prevention improves outcomes of the patients with alcohol dependence. The objective of this study was to study the impact of a brief relapse prevention intervention with involvement of a family member based on Mental Health Gap Intervention Guide, in patients with alcohol dependence, admitted at Chainama Hills Hospital, Lusaka. A randomized control trial was carried out in which 114 participants were recruited from consecutive admissions at Chainama Hills Hospital. One hundred and ten (96.5%) of the participants were males while four (3.5%) participants were females. All participants were between 18-65years of age. All participants met DSM -1V- TR criteria of alcohol dependence and had alcohol dependence screened by AUDIT screening questionnaire. Participants were randomly divided into non-intervention and intervention groups. There were 56 participants in the non-intervention group and 58 participants in the intervention group. Participants in the non-intervention group were given treatment as usual, which consisted of detoxification with diazepam and vitamin supplementation. Participants in the intervention group were given treatment as usual as well as a brief relapse prevention intervention from mhGAP-IG with involvement of a close family member. Both groups were followed up eight weeks after discharge. The outcome measures were time to first relapse following discharge and difference in the AUDIT score of questions 1-3, administered at time of recruitment and at the time of follow up. The intervention group had an average time to first relapse of 51.29 days (91%)(standard deviation=14.085) while the non-intervention group had an average time to first relapse of 10.00 days (18%)(standard deviation=16.542). There was a significant difference between the two groups with the intervention group having a longer time to first relapse (t=14.368; df=112; p=0.001). The frequency alcohol consumption (AUDIT questions 1-3) of the participants was calculated before and after the treatment. Before treatment, the average frequency of alcohol consumption in the intervention group was 10.26 and 10.32 for the non-intervention group, with standard deviations of 1.517 and 1.749, respectively. After treatment, the average frequency of alcohol consumption for the intervention group was 1.33 and 8.96 for the non-intervention group, with standard deviations of 3.063 and 3.885, respectively. The findings of the study show that participants in the intervention group performed better in terms of reducing the frequency of alcohol consumption and took longer to first relapse as compared to the participants in the non-intervention group. This shows that brief relapse prevention intervention from mhGAP-IG is very effective in reducing the frequency of alcohol consumption and preventing relapses among alcohol-dependent patients in a Zambian setting.