RESUMEN
INTRODUCTION AND AIMS: Women are underrepresented in long-term studies of alcohol dependence. While gender differences in drinking behaviour have been observed when starting treatment, very few studies have investigated gender differences in long-term drinking outcomes. This paper evaluates gender differences in the long-term outcome of patients treated for alcohol dependence. DESIGN AND METHODS: A cohort of 850 outpatients (19% women, age 39 ± 9 years) treated for alcohol dependence in specialist centres of Catalonia (Spain) were followed up prospectively for 20 years. Covariance analysis was used to assess gender differences at 1, 5, 10 and 20 years in drinking behaviour, psychosocial stress and social functioning (Axes 4 and 5 of Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised). We evaluated gender differences in drinking trajectories using a multilevel model controlling for basal differences. RESULTS: Women started treatment earlier in their drinking career, with more symptoms of dependence. In the first year they remained in treatment longer and had more clinic visits. Women presented lower alcohol consumption than men at baseline, 5 and 10 years, and similar levels of stress and psychosocial functioning. When basal alcohol consumption, length of treatment and employment were controlled, female gender predicted less drinking at year 1 and a drinking trajectory closer to abstinence between 1 and 20 years. DISCUSSION AND CONCLUSIONS: Increased severity of alcohol dependence in women starting treatment was not associated with a worse prognosis. Women did better while under treatment and achieved a better long-term drinking outcome. Gender differences were not relevant concerning psychosocial stress and social functioning.
Asunto(s)
Alcoholismo/diagnóstico , Alcoholismo/terapia , Caracteres Sexuales , Adulto , Consumo de Bebidas Alcohólicas/terapia , Alcoholismo/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pronóstico , Estudios Prospectivos , Conducta Social , Estrés Psicológico/complicaciones , Estrés Psicológico/terapia , Resultado del TratamientoRESUMEN
INTRODUCTION: Alcoholic cirrhosis is one of the most common indications for liver transplantation (LT) in western countries. A major concern about transplant patients due to alcoholic liver disease (ALD) is alcoholic recidivism. Data concerning psycho-social characteristics of patients with 6 months of abstinence at initial evaluation for LT is scarce. Objectives. The aims of this study were 1) To evaluate the psycho-social profile of a cohort of patients with alcoholic cirrhosis being evaluated for LT. 2) Determine factors associated with abstinence from alcohol at initial psycho-social evaluation for LT and 3) To evaluate the potential impact of alcohol-free beer consumption on 6-month abstinence. MATERIAL AND METHODS: Ninety patients referred to the Alcohol Unit of the Hospital Clínic of Barcelona (January 1995-December 1996) were included. Univariate and multivariate logistic regression analyses were used to identify the factors associated with cessation in alcohol consumption and with 6-month abstinence. RESULTS: Factors associated with cessation in alcohol consumption were awareness of alcohol toxicity (OR = 5.84, CI 1.31-26.11, p = 0.02) and family recognition (OR = 3.81, CI 1.27-11.41, p = 0.01). Cessation of alcohol consumption at knowledge of ALD (OR = 5.50, CI 1.52-19.81, p = 0.009), awareness of alcohol toxicity (OR = 2.99, CI 1.02-9.22, p = 0.05) and family recognition (OR = 5.21, CI 1.12-24.15, p = 0.03) were the independent factors associated with 6-month abstinence previous to psycho-social evaluation for LT. CONCLUSION: In conclusion awareness of alcohol toxicity and family recognition are the independent factors that influence cessation in alcohol consumption and 6-month abstinence in patients evaluated for LT. The use of alcohol-free beer was associated with a higher rate of abstinence in patients without alcohol cessation.