Self-help Articles

By Tom Horvath, Ph.D.

The year following inpatient alcohol rehab is a crucial period of time in which many patients relapse. Several factors may reduce the risk of relapse during this time, including therapy appointments, attendance at mutual help meetings such as Alcoholics Anonymous (AA) or SMART Recovery, aftercare group sessions, and the use of medications such as disulfiram (Antabuse), which produces a heightened sensitivity to alcohol by interfering with the body’s metabolism of alcohol. Researchers in Portugal followed patients who completed an inpatient alcohol rehab program at the Lisbon Regional Alcohology Centre in an effort to delineate the features of aftercare treatment compliance, which predict outcome in aftercare (Neto et. al., 2007).

The researchers followed 74 patients for 6 months after discharge from the inpatient program. The study focused on the predictive value of aftercare therapies including attendance at AA meetings, attendance at aftercare groups, and attendance at outpatient sessions with a medical assistant. Disulfiram was prescribed to 83.3 percent of the patients. At the 6-month follow-up point, the patients and their significant others were interviewed via telephone.

Results show that 39.2 percent of the patients had attained total abstinence at the follow-up point, and 71 percent of the relapses had occurred within the first 3 months of aftercare. The researchers found that the median number of days that patients took disulfiram was significantly related to the number of days of abstinence. However, outcome was not predicted by AA attendance, aftercare group attendance, outpatient appointment attendance, or demographic variables. The authors concluded that consistently taking disulfiram was associated with a good outcome.

Previous studies have suggested that attendance at mutual help groups such as AA or SMART Recovery and aftercare group sessions are associated with positive outcomes following alcohol rehab. In this study, as the authors point out, there was low compliance with the aftercare plan, and this could explain the weak predictive value of group attendance.

The finding that a longer period of disulfiram intake was associated with improved rates of abstinence could be a reflection of the patient’s commitment to abstinence as well as the effect of the drug. Further, in this study, the success of disulfirm was likely due in part to the role of the patient’s significant other or co-responsible person. Treatment providers stressed the importance of the significant other in the observation of disulfiram intake. Patients signed a contract that they would take disulfiram under the observation of their chosen co-responsible person. Perhaps the treatment providers should have also stressed the importance of co-responsibility in regard to meeting attendance and compliance with all aspects of the aftercare plan. In this study, 47.3 percent of patients did not attend outpatient meetings with the medical assistant, 20.3 percent did not attend aftercare groups, and 33.8 percent did not attend AA meetings.

Tom Horvath, Ph.D., is a California licensed and board certified (ABPP) clinical psychologist. He is the founder and president of Practical Recovery, a non 12-step self-empowering addiction treatment system in San Diego. He is past president of the American Psychological Association’s Society of Addiction Psychology (Division 50), the world’s largest organization of addiction psychologists. He is the author of Sex, Drugs, Gambling & Chocolate: A Workbook for Overcoming Addictions (listed by the Association for Behavioral and Cognitive Therapies as a “Self-Help Book of Merit”).

Neto D, Lambaz R, Tavares JE. Compliance with aftercare treatment, including disulfiram, and effect on outcome in alcohol-dependent patients. Alcohol and Alcoholism. 2007; 42(6): 604-609.