A study on bottoming-out experience and continuation of outpatient treatment in alcoholism

Increasing the rate of continuation is considered important in treating alcoholism. The bottoming-out experience is considered essential for continuing treatment. To the best of our knowledge, no evidence-based study has investigated the bottoming-out experience in Japan. We independently defined the bottoming-out experience in this study based on overseas evidence and determined whether there was a difference in the background of alcoholics and the continuation rate of outpatient treatment depending on the presence or absence of the bottoming-out experience. The study participants were patients who made their first visit to the addiction outpatient clinic of Showa University Karasuyama Hospital between April 1, 2016 and August 31, 2019 and were diagnosed with alcoholism. Using medical records, we retrospectively surveyed sex, age, the presence/absence of coexisting physical or mental illness, the presence/absence of a roommate, employment status at the time of the first visit, the presence/absence of public assistance, address at the time of the first visit, the presence/absence of a group treatment program at our hospital, participation status in a self-help group, hospitalization status after the first visit, the duration of outpatient treatment, and the presence/absence of the bottoming-out experience before the visit. We conducted univariate and multivariate analyses of the survey items. The multivariate analysis was performed using survival analysis and Cox proportional-hazard model using the Kaplan-Meier method and log-rank test to examine the influence on the continuation of outpatient treatment. The results showed that the presence/absence of the bottoming-out experience did not affect the continuation rate of outpatient treatment when various factors were considered （P＝0.10）. This supports our view that early intervention should be proactively provided in treating alcoholism, instead of waiting for the occurrence of the bottoming-out experience.