One of the challenges in evaluating the effectiveness of alcohol treatment is determining what constitutes a "good" outcome or meaningful improvement. While abstinence at the end of treatment is clearly a good outcome, a focus on abstinence ignores the benefits of patients reducing their drinking to less problematic levels so that they can function better and incur fewer social costs. This study estimates the relationship between drinking practices at the end of a treatment program and subsequent health-care costs, with an emphasis on heavy and non-heavy drinking levels.
Researchers used data from the COMBINE trial, which randomized 1,383 adult participants with alcohol dependence to nine different combinations of medications and psychosocial interventions. For this study, the authors examined heavy drinking days (HDDs) -- defined as five or more drinks for men, four or more for women -- and non-heavy drinking days (non-HDDs) during the last 30 days of COMBINE treatment for 748 patients (524 men, 224 women) enrolled in the COMBINE Economic Study. Total costs were treated as a function of drinking indicators.
Results indicate that having HDDs at the end of treatment is associated with higher costs. For example, patients with HDDs had 66.3 percent higher health-care costs than those who were abstinent, and having more than two HDDs was associated with the highest costs (76.1%). Furthermore, patients who had only HDDs at the end of treatment had worse subsequent outcomes than those who had both non-HDDs and HDDs. These findings offer a new context for evaluating treatment outcomes and provide new information on the association of drinking with adverse consequences.
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