This study suggests that there is a significant improvement in all dimensions of QoL of alcohol-dependent patients after a 20-day inpatient programme for alcohol detoxification and short rehabilitation in an alcohol addiction centre. The number of DSM-IV criteria for dependence was the only factor predictive of both physical and psychological QoL scores of patients on admission.
This study shows that the QoL scores of alcohol-dependent patients on admission to hospital are much lower than those of a general reference population. Several other authors have also used the SF-36 questionnaire to measure QoL of alcohol-dependent patients and found scores to be decreased across all dimensions of the scale at the start of a treatment programme. As in our study, the scores for the psychological dimensions were reduced more than those for the physical dimensions, in particular the scores for role limitations due to emotional problems and social functioning 13, 15-19, 33, 34
We have shown that the initial QoL of our patients was associated with several factors, stemming from the alcoholic disease itself, its consequences, and from somatic or psychiatric comorbidities. The relationship between severity of dependence and QoL of alcohol-dependent patients has been investigated by other authors by measuring the correlation between SF-36 scores and ASI (Addiction Severity Index) 9, 13, 18, 35
. The pain, mental health and physical capacity dimensions appeared to be most closely correlated to ASI scores and, as in our study, the severity of dependence appeared to be the alcohol-related variable that had the strongest impact on QoL. The level of alcohol intake of patients did not appear to affect their QoL, maybe because all of our dependent patients had excessive alcohol intake. Other authors have also demonstrated that in the absence of dependence, the mode of alcohol consumption has a strong influence on QoL: heavy drinkers (at least one intake of alcohol greater than five drinks in the previous month) had a poorer QoL than other alcohol drinkers, whereas smaller regular drinkers (less than five drinks per occasion) had a better QoL than other drinkers 20, 36
. We have also shown that some sociodemographic variables such as age >45 years, female gender, emotional isolation, socioprofessional category labourer or employee, had a negative relationship with QoL. Our conclusions agree with those of other authors: female gender, older age, emotional loneliness or absence of close support, low level of education, redundancy or inactivity, socioeconomic insecurity, marital or familial conflicts are the sociodemographic factors mentioned most often in the literature 10, 14, 16, 20, 37
. In our study, somatic or psychiatric comorbidities to alcohol dependence significantly decreases QoL, as mentioned previously by other authors 20, 38, 39
. Our study and these previous studies do not enable us to identify exactly which variables have the greatest influence on QoL. A study carried out in identical twins identified four parameters that explained the difference in QoL between alcohol-dependent twins and alcohol-dependent twins abstinent from alcohol for more than 5 years: severity of dependence, way of life (marital status, level of resources), somatic or psychological comorbidities, existence of associated dependencies 18
. In our study, the presence of abuse or dependence on another substance did not affect the QoL of patients, apart from smoking for psychological QoL. Abuse or dependence on illegal drugs was associated with a large progression of Mental Component Summary Score.
The QoL of patients increased significantly during their residential stay. We have found two studies in the literature which, like ours, investigated the improvement in QoL of alcohol-dependent patients during a residential stay of 1 and 3 weeks. In both of these studies, the QoL of patients was also significantly higher at the end of their stay than on admission 40, 41
. Several factors could explain this great improvement in QoL: cessation of alcohol intake, resolution of withdrawal syndrome, resocialisation of patients through various meetings and other informal exchanges during their stay, reassuring therapeutic environment, restoration of a better self-image by improvement in personal care. Other studies carried out in alcohol-dependent outpatients demonstrated an improvement in QoL when patients were abstinent 22, 23, 42-44
. Apart from abstinence, our study enabled us to identify several factors linked to a favourable short-term improvement in QoL: excessive alcohol consumption and the absence of somatic comorbidity for physical QoL; abuse or dependence on illegal drugs and the absence of psychotic symptoms for psychological QoL. The improvement in QoL was more pronounced when the score on admission was low. This result demonstrates that residential care is highly effective in patients with a poor QoL on admission but also perhaps reflects rapid normalisation of QoL during therapy. In a review of the literature, we were able to find several factors that are predictive of improved QoL in alcohol-dependent patients over several weeks of residential care and in outpatients. These include regular psychosocial support, presence of a close family circle or neighbours and effective control of alcohol intake 16, 17, 43
. Our results are difficult to compare with these, since our follow-up period was limited by the length of hospitalisation and was therefore much shorter. Nevertheless, they justify initiation of psychosocial support and the management of somatic or psychiatric comorbidities in patients undergoing alcohol detoxification as a strategy to improve QoL.
Several limitations exist with respect to the interpretation of the data. Firstly, our study did not permit us to differentiate between the impact of abstinence itself and that of the hospital environment on the improvement in QoL of alcohol-dependent patients. Secondly, our results do not provide an adequate demonstration of definitive improvement in QoL of alcohol-dependent patients due to the inpatient programme, since we did not follow the patients over the long-term after discharge. The short duration of follow-up (the length of hospitalisation was 19 days on average) does not allow us to predict the impact of certain variables on long- or medium-term evolution of QoL in these patients. Thirdly, the absence of a control group did not enable us to any particular aspect of care that contributed specifically to the improvement in QoL of our patients. Fourthly, thirteen percent of the patients included in our study did not complete the QoL questionnaire at the end of treatment. Their questionnaires on admission were not significantly different from those of the other patients included in the study and the proportion of these patients was similar in the three groups studied, even if this does not necessarily ensure that their QoL would have evolved the same way as those patients that remained in the programme. Finally, our results, which were obtained from a single centre, do not cover all therapeutic options and should be generalised with caution.