Change in Heavy Drinking among Alcohol-Dependent Individuals
Heavy drinking* is predictive of the development of alcohol use disorders and is associated with adverse health outcomes; nevertheless, its natural history among individuals with dependence is not well known. This study analyzed National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data to capture the natural history of heavy drinking and factors associated with change over time. Individuals meeting DSM-IV criteria for alcohol dependence (AD) at baseline were included in the study (n=1484). Those who provided data 3 years later (n=1123) (76%) comprised the study sample.
- Mean number of heavy drinking days (HDD) per year decreased from 119 to 83 over the 3-year period. In multivariable models, this reduction was independently associated with the following:
- smoking (mean reduction of 15 versus 28 HDD among nonsmokers).
- alcohol tolerance (mean reduction of 13 versus 29 HDD for those without tolerance).
- no longer meeting AD criteria (mean reduction of 44 HDD versus those who still met AD criteria, who had a mean increase of 1 HDD).
- Resolution of depression/dysthymia, sex, education, family history of AD, drug use, and bipolar disorder were not associated with HDD reductions in fully adjusted models.
*Defined as ≥5 drinks in a day for men and ≥4 drinks in a day for women in this study.
Comments:
This exploratory study provides insight on the natural history of heavy drinking among individuals with dependence and indicates significant reductions in HDD over time. Smoking and alcohol tolerance appear to have a negative impact on heavy drinking in the long-term for patients with dependence. The fact that smoking is associated with less reduction in HDD should encourage clinicians to target it in individualized interventions.
Nicolas Bertholet, MD, MSc
Reference:
Sarsour K, Johnston JA, Milton DR, et al. Factors predicting change in frequency of heavy drinking days among alcohol-dependent participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Alcohol Alcohol. 2012;47(4):443–450.