Quality of life measures and outcome in alcohol-dependent men and women

Abstract

A sample of 82 (41 men 41 women) DSM IV alcohol-dependent inpatients admitted for detoxification was studied at baseline and followed-up 12 weeks thereafter. The following questionnaires were administered 4–5 days after admission for detoxification: Socio-demographic information, Severity of Alcohol Dependence Questionnaire (SADQ), Alcohol Problems Questionnaire (APQ), Rotterdam Symptoms Checklist (RSCL), Life Situation Survey (LSS), Beck Depression Inventory (BDI), General Health Questionnaire (GHQ 12), and Nottingham Health Profile (NHP). All indices other than socio-demographic data, the SADQ, and APQ were administered at 12-week follow-up. After controlling for confounding factors at baseline, women were more likely to be in a higher social class, prescribed anti-depressants during the previous 12 months, drink fewer units of alcohol in a typical week, and have a higher level of psychiatric caseness scores (GHQ-12). A total of 80 subjects (97%) were successfully followed-up. Difference between gender did not significantly impact upon any of the 12-week outcome measures. There was no significant difference in the study relapse rates or time taken to relapse between men and women. The only significant total sample change was a reduction in the amount of alcohol consumed in a typical week. This was significantly related to changes in the following Quality of Life (QoL) measures, NHP emotional reaction sub-scores, LSS, and BDI scores.

Introduction

Although the overall prevalence of drinking in women has been stable in the United States at around 60% of women between 18 and 65 for the last two decades. There has been a large increase in the amount consumed by younger women aged 18–25 (Fillmore, 1987) and alcohol-related problems are increasing in this patient group (Heltzer et al., 1988). These trends have also been repeated in the United Kingdom (Paton, 1994). As a result, the special treatment needs of alcohol-dependent women have become an increasingly important facet of addiction research and practice. A review of the development and emergence of programmes specifically designed to address the needs of women is found in Schmidt and Weisner (1995). The Swedish Karolinska Project for the Early Treatment of Women with Alcohol Addiction (EWA project) (Dahlgren & Willander, 1989) aimed to provide easily accessible treatment to women early in their drinking careers and has highlighted the strengths of women only programmes.

Although many theories have been put forward to explain the unique treatment needs of women compared to men, there is little systematic data comparing male and female alcohol misusers (Gomberg, 1993). This has led to a number of misconceptions. For example, empirical testing does not support the widespread belief that women “hide” their drinking Ferrence, 1980, Fillmore et al., 1995.

Gomberg (1993) points out those issues specifically pertaining to women. These include a greater physiological vulnerability to the effects of alcohol, in particular, hepatic diseases, child care issues, the linking of drinking to a “Significant Other”, a shorter drinking career before problematic drinking is reached, low self-esteem, and the frequent occurrence of concomitant affective disorders. When reviewing the work to date on the effects of body mass upon women, Graham et al. (1998) suggests that when the differences in drinking patterns can be assumed to be minimal, an adjustment for gender should be made if assessing the short- or long-term physiological effects of alcohol. Other recent work has focused upon the differing patterns of relapse and the link between childhood or adolescent sexual abuse and the development of dependency Jarvis et al., 1998, Spak et al., 1998. Women have been shown to take a longer period to return to heavy drinking than men (Saunders et al., 1993), and are more likely than men to relapse in the presence of “same sex friends” or “romantic partners” (Rubin et al., 1996).

In contrast, there is a literature concerning some of the characteristics which relate to alcohol-dependent men. They tend to be heavier drinkers and start drinking at an earlier age (Miller & Cervantes, 1997). Men are also more likely to develop alcohol-related illnesses by a ratio of 2.2:1 (Commonwealth Department of Human Services and Health, 1995) and report more episodes of delirium tremens, blackouts and alcohol-related accidents (Rimmer et al., 1971). There are also differences concerning the precursors of treatment. It is reported that there is a higher likelihood of men seeking treatment for alcohol-related problems (Allen et al., 1998). Women are more likely to present to psychiatric services with affective disorders such as major depression and anxiety-related symptoms, while antisocial personality disorder and antisocial symptoms are more prevalent in alcohol-dependent men (Cornelius et al., 1995).

Quality of Life (QoL) has become an increasingly important outcome measure in clinical and biomedical research. It privileges the subjective judgement of the patient over objective “hard endpoints” (Longabaugh et al., 1994) such as abstinence or reduction in biochemical measures. These “hard endpoints” may have little relationship to the QoL of the patient. Thus, it becomes important to consider the subjective judgement of the patient when assessing treatment outcomes.

Over 1000 articles are indexed annually under the heading “QoL” (Muldoon et al., 1998). Yet a review of this literature (Foster et al., 1999) found only 35 articles on the Medline/BIDS databases after the words “QoL” and “alcoholics” were entered. This review found that the QoL of alcohol-dependent subjects was poor compared to general populations and that the factors that contribute to this were psychiatric co-morbidity, social environment, pain and disturbed sleep. To date, there have been only two published papers that have applied generic QoL measures in longitudinal studies; the present research group Foster et al., 1998a, Foster et al., 1998b wrote both. Another omission is that there have been no studies to date that provide any information as to whether QoL instruments measure the same constructs in men and women.

This report compares the QoL across a number of indices for men and women attending a voluntary sector alcohol detoxification unit in inner-city London, at baseline and 12-week follow-up. The aim was to ascertain the differences between the two groups and gain some insight as to the impact of gender on longitudinal outcomes.