INTRODUCTION
Excessive alcohol consumption is a major public health issue that can result in severe physical, psychological, and social consequences. While moderate drinking might confer certain health benefits, excessive drinking is associated with more than 60 diseases and injuries, including cancers, cardiovascular and digestive disorders, mental illnesses, and accidents such as car crashes, homicides, and suicides. Alcohol-related causes account for 3.2% of all deaths globally and 9.4% of deaths in South Korea [1,2].
Alcohol use disorder (AUD), a critical outcome of excessive drinking, is characterized by withdrawal symptoms, tolerance, and cravings [3]. It is a major global mental health concern, frequently co-occurring with other substance use disorders, depression, and severe conditions such as liver disease and cancer. Additionally, AUD is associated with various psychosocial issues, including violence and suicide [4,5].
According to the 2021 Mental Health Survey [6], South Korea has the highest lifetime prevalence of AUD (11.6%) among all mental disorders, yet it has the lowest treatment rate [7]. Only 3.4% of individuals diagnosed with AUD utilize mental health services and just 3.2% seek psychiatric care [8]. This treatment gap is largely attributed to low public awareness of AUD, despite strong evidence supporting the effectiveness of medical interventions such as cognitive behavioral therapy, psychiatric counseling, and anti-craving prescriptions. In South Korea, naltrexone and acamprosate are commonly prescribed to reduce alcohol cravings. Randomized controlled trials have demonstrated their efficacy in maintaining abstinence [9,10].
However, most existing research studies have focused on treatment infrastructure [11,12] and the effectiveness of anti-craving prescriptions [13,14], with relatively few studies examining alcohol-related comorbidities and mortality. Despite high mortality rates among patients with alcohol-related diseases, limited research exists on this topic due to challenges in linking hospital records to national datasets.
Thus, this study investigated the status of psychiatric therapy and anti-craving prescriptions in patients with alcohol-related diseases and evaluated their effects on patient prognosis. Utilizing anonymized data compiled at the Gangwon Pseudonym Information Center, this research aimed to inform strategies for managing alcohol-related diseases in Gangwon Province by analyzing patient characteristics, treatment patterns, and outcomes.
METHODS
Subject sampling
This study included 1,667 patients diagnosed with alcohol-related diseases between 2012 and 2021. Disease codes for alcohol-related conditions were defined and data were extracted accordingly (Table 1). This study was approved by the Institutional Review Board (IRB) of Hallym University Chuncheon Sacred Heart Hospital (IRB No. Chuncheon-2022-08-016-002).
Data from hospital records were linked to National Health Insurance Service (NHIS) data and mortality records from the National Statistical Office. To facilitate data integration, a linkage key based on identifiable information (e.g., name, date of birth) was developed in consultation with relevant institutions (Figure 1). Pseudonymized linkage keys were generated and used to integrate datasets while ensuring patient anonymity.
Hospital data included regional alcohol-related diagnoses, treatment records, and behavioral health data. These were combined with NHIS records of alcohol addiction treatment and prescription data, followed by additional de-identification.
The integration of datasets was necessary because hospital data alone were insufficient to analyze economic conditions, comorbidities, or mortality of patients. While hospital data could confirm visits to the psychiatry department, it could not determine whether psychiatric therapy was received. To overcome this limitation, data from hospitals, NHIS, and the National Statistical Office were combined using unified pseudonymous identifiers.
Data extraction and variable definition
Variables were established based on clinical, social, and financial perspectives (Table 2). This study tested two hypotheses (Figure 2):
Hypothesis 1: The provision of psychiatric interventions varied based on patients’ socioeconomic and clinical factors.
Hypothesis 2: Psychiatric therapy and anti-craving prescriptions could affect mortality among patients with alcohol-related diseases.
To test these hypotheses, patients were categorized into three groups based on whether they received psychiatric therapy and/or anti-craving prescriptions (Table 3). Survival time was defined as the period from the first alcohol-related diagnosis to death within a 10-year study window. Group comparisons were conducted using survival analysis. KoreaPlus Statistics (Embeded on SPSS Statistics 29) was used for data preprocessing and SPSS (IBM Corp.) was used for statistical analysis. t-tests and one-way analysis of variance (ANOVA) were performed.
RESULTS
Demographics
After integrating datasets, records of 1,277 patients were obtained. Table 4 summarizes key variables. As shown in Table 5, the average age of patients was 52.19 years. A total of 109 patients had died. Regarding comorbidities, 773 patients had hypertension and 909 had diabetes mellitus, indicating a high prevalence of endocrine diseases among this population.
Of all patients, 731 (57.2%) received psychiatric therapy and 293 (22.9%) received anti-craving prescriptions. Among them, 214 were prescribed acamprosate, 155 were prescribed naltrexone, and 155 received both, indicating that dual prescriptions were often used for patients with liver disease.
Testing hypothesis 1
Based on the classification in Table 3, patients were divided into three groups and compared using one-way ANOVA (Table 6). Group 1 demonstrated the lowest average number of hospitalizations per individual and number of drinks per week, which might indicate that this group comprised patients who had been recently diagnosed with alcohol-related diseases. Group 1 had the lowest mortality rate, while Group 2 had the highest. This indicated that psychiatric therapy alone might be insufficient and that combining it with anti-carving prescriptions and psychiatric therapy could lower mortality. Economic factors also differed significantly among groups, suggesting that socioeconomic status could affect access to anti-carving prescriptions and psychiatric therapy.
Testing hypothesis 2
Deceased patients who received both psychiatric therapy and anti-craving prescriptions were compared with those who did not. Results are shown in Table 7. All patients in the treatment group were males. They were younger on average than those who did not receive treatments.
The incidence of cancer—especially liver cancer—was higher in the treatment group. Furthermore, 53.85% of these patients visited the emergency department, indicating more severe conditions.
Nonetheless, the average survival period was longer for the treatment group (9.44 years) than for the non-treatment group (8.92 years), suggesting that combined treatment could improve long-term survival (Table 8).
DISCUSSION
This study validated two hypotheses using integrated datasets on clinical, economic, and mortality variables among patients with alcohol-related diseases. Three key findings emerged.
First, combining psychiatric therapy with anti-craving prescriptions significantly improved patient survival. Patients who received both treatments had better outcomes than those who received only one treatment. The effectiveness of naltrexone and acamprosate in reducing alcohol consumption and prolonging abstinence is well-supported in clinical literature [15-17]. These findings highlight the value of multidisciplinary care in managing AUD.
Second, socioeconomic status significantly affected treatment access. Patients with higher incomes were more likely to receive pharmacological treatments, reflecting broader healthcare disparities. Prior research supports that lower-income populations, especially in urban areas, are at greater risk for AUD and worse treatment outcomes [18-21]. Thus, policy efforts are needed to address these gaps.
By integrating data of comorbidities, mortality, and economic status, this study provides a more comprehensive understanding of AUD treatment. Classifying patients by treatment type allows more nuanced analysis. However, this study was limited to hospitalized patients. Thus, larger, more diverse populations should be examined in future research. Another limitation of this study was that observed outcomes might reflect differences in patient conditions rather than effects of psychiatric therapy or anti-craving prescriptions. Thus, longitudinal studies are needed in the future to assess the long-term impact of different treatment modalities on AUD prognosis.
In conclusion, alcohol-related diseases pose serious threats to both individual health and societal wellbeing, making timely intervention essential. This study demonstrates that combining psychiatric therapy with anti-craving prescriptions, particularly naltrexone and acamprosate, is effective in prolonging survival among AUD patients. Understanding each patient’s clinical and socioeconomic background is crucial for tailoring effective treatments. Integrating diverse alcohol-related datasets enables personalized care, which might help reduce mortality and alleviate the broader societal burden of alcohol-related diseases.
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