Background: This was a national English observational cohort study to estimate the effectiveness of inpatient withdrawal (IW) and residential rehabilitation (RR) interventions for alcohol use disorder (AUD) using administrative data. Methods: All adults commencing IW and/or RR intervention for AUD between April 1, 2014 and March 31, 2015 reported to the National Drug Treatment Monitoring System (n = 3812). The primary outcome was successful completion of treatment within 12 months of commencement, with no re-presentation (SCNR) in the subsequent six months, analysed by multi-level, mixed effects, multivariable logistic regression. Results: The majority (70%, n = 2682) received IW in their index treatment journey; one-quarter (24%, n = 915) received RR; 6% (n = 215) received both. Of treatment leavers, 59% achieved the SCNR outcome (IW: 57%; RR: 64%; IW/RR: 57%). Positive outcome for IW was associated with older age, being employed, and receiving community-based treatment prior to and subsequent to IW. Patients with housing problems were less likely to achieving the outcome. Positive outcome for RR was associated with paid employment, self/family/peer referral, longer duration of RR treatment, and community-based treatment following discharge. Community-based treatment prior to entering RR, and receiving IW during the same treatment journey as RR, were associated with lower likelihood of SCNR. Conclusions: In this first national effectiveness study of AUD in the English public treatment system for alcohol-use disorders, 59% of patients successfully completed treatment within 12 months and did not represent for more treatment within six months. Longer duration of treatment and provision of structured continuing care is associated with better treatment outcomes.
Bibliographical noteFunding Information:
B.E. is enrolled at a part-time PhD programme at King's College London. He is employed full-time at Public Health England with the Evidence Application Team, Alcohol, Drugs and Tobacco Division, Public Health England. A.P. is supported by a National Health and Medical Research Council Early Career Fellowship (#APP1109366). A.P. works at the National Drug and Alcohol Research Centre, which is funded by the Australian Government as part of the National Drug Strategy. She has received untied educational grants from Mundipharma and Seqirus for post-marketing surveillance of pharmaceutical opioid formulations. J.M. works in an integrated university and National Health Service academic health sciences centre (Institute of Psychiatry, Psychology and Neuroscience [IoPPN], King's College London and King's Health Partners). He is supported by research grants from the Department of Health, Institute for Health Research (NIHR), and the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Mental Health Foundation Trust (SLaM MHFT) and has part-time employment as Senior Academic Advisor for the Alcohol, Drugs and Tobacco Division, Health and Wellbeing Directorate, Public Health England. He declares untied educational grant funding from the pharmaceutical industry at IoPPN and SLaM MHFT for a study of psychological interventions in opioid maintenance (2010–2016; Indivior PLC via Action on Addiction). In the past three years he has received honoraria from Merck Serono in 2015 (clinical oncology medicine) and from Indivior via PCM Scientific in relation to the Improving Outcomes in Treatment of Opioid Dependence conference (co-chair, 2015; 2016; chair: 2017). He holds no stocks in any company. All other authors have no disclosures in relation to this article.
The study was supported by the Alcohol, Drugs and Tobacco Division, Health Improvement Directorate, Public Health England. The contents of this article do not necessarily reflect the views or stated position of PHE.
- Alcohol use disorder