Continuing care for patients with alcohol use disorders: a systematic review

Abstract

Background: A chronic care perspective should be adopted in the treatment of patients with alcohol use disorders (AUDs). Initial treatment in a more intense psychiatric care setting should be followed by continuing care. This systematic review aims to identify effective continuing care interventions for patients with AUDs.

Methods: Electronic databases were searched up to February 2013 (MEDLINE, EMBASE, CENTRAL, CINAHL and PsycINFO) to identify RCTs studying continuing care interventions for patients with AUDs. Study selection and quality appraisal was done independently by two reviewers. Drinking and treatment engagement outcomes were considered. Relative risks and mean differences were calculated with 95% confidence intervals. A statistical pooling of results was planned.

Results: 20 trials out of 15,235 identified studies met the inclusion criteria. Only six were evaluated as methodologically strong enough and included for further analysis. Interventions ranged from telephone calls and nurse follow-up to various forms of individual or couples counseling. Four trials suggested that supplementing usual continuing care with an active intervention empowering the patient, could be beneficial to drinking outcomes. Effect sizes were limited and not consistent across all outcomes. Because of heterogeneity in the interventions and outcome measures, a meta-analysis could not be performed.

Conclusion: For the treatment of a disease with such devastating consequences, it is remarkable how few high quality studies are available. Adding an active intervention to usual continuing care seems to improve treatment outcomes. We propose an integrated care program with different elements from the selected studies and discuss implications for further research.

Keywords: Aftercare; Alcohol use disorders treatment; Continuing care; Integrated care; Substance use disorders treatment.