Effectiveness of tele-counseling for patients with alcohol dependence syndrome - A randomized control trial.

Abstract

Background: There is a rising trend of alcohol addiction in our Indian society. Studies from high-income countries have demonstrated the effective usage of mobile phones in delivering psychosocial interventions in the treatment of substance disorders.

Aim: To assess the effectiveness of Tele-Counseling as a mode of continuing care for patients with alcohol dependence syndrome.

Materials and methods: An open-label randomized control trial was conducted with 78 male participants. Patients with severe mental disorders or cognitive impairments were excluded. Participants received standard care treatments and were randomly assigned to either the Tele-Continuing Care (TCC) group or the Treatment as Usual (TAU) group. 1) 'Telephone Continuing Care ' group (TCC) who received pro-active contact and counseling through mobile phones from the treatment team on the 1^st, 2^nd, 4^th, 8^th, 12^th, 16^th, 20^th, and 24^th week after discharge. 2) The 'Treatment-As-Usual' group (TAU) received usual outpatient follow-up care. We contacted patients and their caregivers every month over mobile phones, belonging to both groups and collected information regarding drinking status up to one year after discharge. We compared abstinence rates, drinking percentage days, and treatment adherence rates. By including all the variables, we did logistic regression to predict relapse.

Results: The mean age of participants was 41.38 ± 9.06 years, with the majority being married. A higher percentage of patients in the TAU group had higher education qualifications compared to the TCC group. Duration of treatment adherence was significantly (P = 0.017) longer in the TCC group than TAU group (159.83 (120) ±129.47 vs. 100.37 (60) ±112.95) days. Similarly, compliance with abstinence-maintaining medications was better (P = 0.027) in the TCC group than TAU group (142.85 (120) ±115.50 v/s 95.29 (52.5) ±104.42) days. Attendance to group therapy sessions also was better in the TCC group (P = 0.001) compared to the TAU group. However, there was no statistical significance between the two groups in terms of abstinence rate at the end of one year (TCC: 61.8% and TAU: 44.4%) and also the drinking percentage days at the end of one year (TCC 28.22% vs. TAU 38.76%). Logistic regression revealed that a Family History of Alcoholism and Poor Drug compliance were found to be significant predictors of relapse.

Conclusion: As Tele-Counselling Care in our study showed partial effectiveness in improving the outcome measures, research should focus on improvising further to strengthen the Tele-Counselling model, especially in resource crunch Low- and Middle-Income countries and this could be included in the armamentarium of alcohol de-addiction program.