Most Alcohol Use Disorders Remit, but Unhealthy Drinking Often Persists

People with alcohol use disorders (AUDs) commonly remit, but subsequent rates of unhealthy drinking among this population remain uncertain. This prospective cohort study identified 198 adults in the Netherlands with DSM-5 AUDs and followed them for 3 years to examine changes in drinking patterns.

• At baseline, 69% of participants had a mild AUD (2–3 DSM-5 criteria); 17% had a moderate AUD (4–5 criteria); and 25% had a severe AUD (≥6 criteria).
• AUD persisted among 30% of the 115 participants assessed at the 3-year follow-up.
• Adults aged 18–24 years at baseline had a 7-fold higher risk of AUD persistence than those aged 25–44 years. More weekly drinks (odds ratio [OR], 1.03 per drink) and a co-occurring anxiety disorder (OR 4.6) were also associated with increased AUD persistence.
• Among individuals whose AUD remitted at 3 years, 55% drank at lower-risk levels (≤7 standard drinks per week for women, ≤14 for men), 36% drank above those limits, and 9% abstained.
• The mean change in number of weekly drinks was associated with AUD persistency: +9.6 for those with AUD persistence and -5.5 for those who remitted.

Comments:

Most adults with AUDs (70%) remit within three years, but over 90% of those in remission continue to drink and over one-third continue to drink at unhealthy levels. Given the ongoing risk of relapse associated with continued drinking, this study suggests a need for ongoing monitoring and maintenance care among patients with a history of an AUD even after 3 years of remission. Primary care physicians should assess alcohol consumption and consequences among such patients at periodic visits, and deliver brief counseling emphasizing that abstinence remains the safest option.

Peter D. Friedmann, MD, MPH

Reference:

Tuithof M, Ten Have M, van den Brink W, et al. Predicting persistency of DSM-5 alcohol use disorder and examining drinking patterns of recently remitted individuals: a prospective general population study. Addiction. 2013;108(12):2091–2099.