Effectiveness of inpatient alcohol detoxification and psychotherapeutic support program: a prospective self-controlled study at a tertiary hospital in Nepal

Abstract

Background and objectives: Alcohol use disorder is prevalent or common and associated with a range of physical and mental sequelae. Treatment gap exists in low and middle income countries. This study aims to evaluate effectiveness of inpatient detoxification with concomitant psychotherapeutic support in terms of readiness to change and abstinence maintenance. Subjects and methods: This prospective self-controlled study included 109 patients admitted for alcohol use disorder (age: 42.5 ± 9.3 years; male: 90.8%) in a tertiary level hospital (inpatient unit at Department of Psychiatry and Mental Health at Tribhuvan University Teaching Hospital in Kathmandu). They underwent 10–14 days of inpatient detoxification and psychotherapeutic support program. Baseline assessments were done during admission, and follow-ups were done just prior to discharge, 2 weeks and 3 months after discharge. After 3 months, 63 participants were contacted through phone. Primary outcome measures were readiness for change, reflected in scores on The Stages of Change Readiness and Treatment Eagerness Scale, and status of abstinence maintenance. Ethical approval was taken from Institutional Review Board, Institute of Medicine, Tribhuvan University on December 29, 2017. Results: Results showed statistically significant reduction in “ambivalence,” and improvement in “taking steps” during discharge as well as 2 weeks after discharge in comparison to the baseline measures (P < 0.001). However, there was no significant change in “recognition.” In the 3-month follow-up, 73% of the participants were in complete abstinence; 6.3% had few drinks (up to three drinks) on a couple of occasions; and 20.6% relapsed. Conclusion: Brief inpatient treatment, incorporating pharmacological detoxification as well as psychotherapeutic support helps in enhancing readiness to change as well as maintaining alcohol-free lifestyle. Scaling up such packages to reduce treatment gap in low and middle income countries like Nepal is highly needed. Trial registration: This trial was registered in ClinicalTrials.gov (NCT03988478).