Employment Status of Alcohol-Dependent Patients a Year after Inpatient Treatment
Question:
Does the proportion of individuals in employment increase after inpatient treatment and which characteristics are prognostically relevant?
Method:
Retrospective field study of inpatient behaviour therapy with the goals of abstinence and fitness for work in accordance with the guidelines of the German pension insurance scheme. The interventions included the following: behaviour analysis, motivational interview, relapse prevention, social skills training, cognitive therapy and application training. Changes in employment status were determined using the McNemar Test, differences between employed and unemployed persons were tested with three-factor variance analysis and predictors with binary logistic regression.
Results:
After treatment, a significantly higher proportion of the 396 alcohol-dependent patients were in employment. 89,2 percent of those who were working at the beginning of treatment (N = 194) remained in employment, although when they started treatment they were in considerable danger of becoming unfit for work. Among the unemployed (N = 150), 28 percent of whom started working, the main predictors for an employment situation at one-year follow-up were six months of abstinence after the end of treatment (OR = 3,3; p = .001) and a younger age (OR = 2,8; p = .001). Partner situation, education, treatment experience, psychic comorbidity or depression or personality disorders were not prognostically relevant. 54.3 percent of the patients had been continuously abstinent for the 12 months since the end of treatment. Of these patients, only 15.8 percent were unemployed at one-year follow-up. A third of the patients who had relapsed were working at one-year follow-up in spite of their alcohol consumption. Younger patients (< 43 years old) were more likely to be working a year after the end of treatment (p < .001), older patients (< 51 years old) more likely to be abstinent (p = .006).
Conclusions:
The results confirm the hypothesis that inpatient treatment results in an increase of both abstinence and the proportion of individuals in employment. Although abstinence is the most important condition for fitness for work, it is worth investigating which patients under which conditions and with which drinking patterns succeed in starting or staying in work. In spite of the high costs, three months’ inpatient treatment is worthwhile not only for health and social reasons, but also from an economic point of view.