Here’s an interesting abstract from looking at relapse patterns for alcoholics taking medication for their alcoholism–they increased their drinking before discontinuing their medication.
We use intensive longitudinal data methods to illuminate processes affecting patients’ drinking in relation to the discontinuation of medications within an alcohol treatment study. Although previous work has focused on broad measures of medication adherence, we focus on dynamic changes in drinking both before and after patients discontinue.
We conducted secondary data analyses using the COMBINE study, focused on participants who discontinued medications prior to the planned end of treatment. Using an interrupted time series analysis, we analyzed drinking in the weeks before and after discontinuation and also studied outcomes at the end of the COMBINE follow-up.
Unites States of America.
We describe the sub-sample of COMBINE participants who discontinued medications (n=450), and compare them with those who were medication adherent (n=559) and with those who discontinued but had substantial missing data (n=217).
The primary outcomes were percent days abstinent (PDA) and percent heavy drinking days (PHDD). Medication adherence data were used to approximate the date of discontinuation.
For many patients, an increase in drinking began weeks before discontinuation (PDA: F(1,4803) = 19.07, p < .001; PHDD: F(1,4804) = 8.58, p = .003) then escalated at discontinuation (PDA: F(1,446) = 5.05, p = .025; PHDD: F(1,446) = 4.52, p = .034). Among other effects, the amount of change was moderated by the reason for discontinuation (e.g., adverse event; PDA: F(2,4803) = 3.85, p = .021; PHDD: F(2,4804) = 5.36, p = .005) and also whether it occurred in the first or second half of treatment (PDA: F(1,4803) = 5.23, p = .022; PHDD: F(1,4804) = 8.79, p = .003).
A patient’s decision to stop taking medications during alcohol treatment appears to take place during a weeks-long process of disengagement from treatment. Patients who discontinue medications early in treatment or without medical consultation appear to drink more frequently and more heavily.
The medications involved were naltrexone and acomprosate.
In the discussion, the writers say the following:
Not surprisingly, the patients who stopped medications on their own initiative did badly, especially those who stopped early in treatment. Such patients may be poorly motivated, demoralized, or unprepared for the demands of a rigorous treatment protocol. Perhaps no professional intervention could reach all of these patients, but at least some doors should be left open to encourage their return to of treatment. Clinical policies favorable to patient admission of relapse and/or continued alcohol use could serve to improve dialogue between provider and patient, and perhaps prevent discontinuation.
The “demands of a rigorous protocol”? As far as I can tell, subjects participated in up to 20 outpatient sessions over 16 weeks. Talk about low expectations.