Video of Patient’s Own Delirium Tremens Decreases Relapse Risk

Confrontational approaches to convince patients with alcohol dependence that they are harming themselves tend to be ineffective. Hypothesizing that one such approach might increase patient insight into the disease, researchers assessed whether showing a patient a videotape of his own delirium tremens (DTs) might decrease relapse.

Sixty men hospitalized for alcohol withdrawal delirium were videotaped and randomly assigned to either (1) view the tape and meet with a psychiatrist who explained the DTs or (2) view the tape, if they chose, at the end of follow-up (controls). Patient and family interviews assessed alcohol use and relapse.*

• At 1 month, none of the intervention subjects but 20% of the control subjects had relapsed.
  At 6 months, the proportions were 47% and 70%, respectively.

• Subjects assigned to watch the video, compared with controls,
  • had a longer time to relapse (210 versus 109 days);
  • drank less (about 25 versus 28 drinks per week at 6 months);
  • drank on fewer days (5 versus 6 days per week at 6 months).

Comments:

The results from this unusual treatment are surprising and should be confirmed in other studies given the small and selected sample. An editorialist points out that a single intervention that might increase motivation would not improve self-efficacy or provide skills required to reduce risk of relapse. Nonetheless, these findings should make clinicians rethink a role, in the context of known effective therapies, for showing patients the consequences of their drinking.

Richard Saitz, MD, MPH

Reference:

Mihai M, Damsa C, Allen M, et al. Viewing videotape of themselves while experiencing delirium tremens could reduce the relapse rate in alcohol-dependent patients. Addiction. 2007;102(2):226–231.

Bühringer G, Hoch E. Viewing videotapes of one’s own delirium tremens: renaissance of alcohol dependence as ‘disease of the will’? Addiction. 2007;102(2):183–184.