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Mark L. Willenbring, MD; Douglas H. Olson, PhD

Arch Intern Med. 1999;159:1946-1952.

Background  Medically ill alcoholics often do not respond to conventional alcoholism treatment or decline physician referrals. Integrated outpatient treatment (IOT), a new treatment specifically designed for this population, combines comprehensive medical care with alcoholism interventions.

Objective  To compare the efficacy of IOT with that of standard treatment approaches.

Methods  One hundred five male veterans with severe medical complications caused by alcoholism and recent drinking were randomly assigned to receive IOT or referral to standard alcoholism and medical treatment and were evaluated over 2 years. Integrated outpatient treatment patients received medical care and alcoholism interventions once or twice monthly. Patients in the control group were referred for alcoholism treatment, but few accepted. However, patients in the control group did engage in outpatient medical care.

Results  At baseline, the mean±SD age of the control group was 57.2±10.0 years, compared with 52.8±11.5 years in the IOT group (P=.04). The groups were well matched in other respects. The mean±SD number of visits over 2 years for the IOT patients was 42.2±29.1, compared with 17.4±15.6 for the control patients (P<.001); the frequency of hospital use was similar in both groups. After 2 years, 28 (74%) of 38 surviving IOT patients and 17 (47%) of 36 control patients were abstinent (P=.02). Nearly twice as many control patients (30% [n=16]) as IOT patients (18% [n=9]) died, but the results of Cox survival analysis were not significant. There were no differences in symptoms of alcohol dependence, quality of life, or life problems. The incremental cost of IOT was approximately $1100 per patient per year.

Conclusions  Standard medical care alone was surprisingly effective in inducing abstinence in surviving medically ill alcoholics. Integrated outpatient treatment significantly increased both engagement and abstinence for a modest annual cost. Further refinement and testing of IOT is indicated.

From the Departments of Psychiatry (Dr Willenbring) and Psychology (Dr Olson), Minneapolis Veterans Affairs Medical Center and the University of Minnesota, Minneapolis.

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