“Problem” Drinkers Drink Less over Time

Alcohol dependence can be a chronic illness, and it is often thought that risky or “problem” use leads to dependence if not addressed. However, few reports using population-based data inform us as to how accurate this assumption is. Investigators conducted in-person interviews with 672 people in northern California identified as problem drinkers* via random-digit-dial telephone screening. Interviews took place in 7 waves over 11 years. Twenty percent of the sample met criteria for alcohol dependence. The mean age of participants was 35; 39% were female, 71% were white, and 40% were married.

• On average, drinking declined over time from 4 to 2 drinks per day for men and 2 to 1 drink per day for women. No more than 10% abstained. Most of the reduction occurred in the first year, with little or no change occurring in the last 6 years.

• Having a heavy-drinking network, suggestions to get help for drinking, and going into treatment were associated with more drinking, while having contact with community agencies and going to Alcoholics Anonymous were associated with less drinking.

Comments:

Unfortunately, this paper did not report whether problem drinking (i.e., drinking too much with adverse consequences) decreased. It is unclear how much change was spontaneous, and the associations between selected exposures and changes in drinking are difficult to interpret (e.g., people may increase their drinking and end up in treatment rather than treatment leading them to drink more). Results do suggest that consumption decreases over time in people who drink too much and have consequences. We need to better understand why some of these people develop dependence, why some spontaneously remit, and why some do not.

Richard Saitz MD, MPH

Reference:

Delucchi KL, Kaskutas LA. Following problem drinkers over eleven years: understanding changes in alcohol consumption. J Stud Alcohol Drugs. 2010;71(6):831–836.