Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up.

< The Drinker by Cezanne

BACKGROUND: There is little information on the stability of abstinent and non-abstinent remission from alcohol dependence in the general U.S. population. The aim of this study was to examine longitudinal changes in recovery status among individuals in remission from DSM-IV alcohol dependence, including rates and correlates of relapse, over a 3-year period.

METHODS: This analysis is based on data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of U.S. adults aged 18 years and older originally interviewed in 2001 to 2002 and re-interviewed in 2004 to 2005. The Wave 1 NESARC identified 2,109 individuals who met the DSM-IV criteria for full remission from alcohol dependence. Of these, 1,772 were re-interviewed at Wave 2, comprising the analytic sample for this study. Recovery status at Wave 2 was examined as a function of type of remission at Wave 1, with a focus on rates of relapse, alternately defined as recurrence of any alcohol use disorder (AUD) symptoms and recurrence of DSM-IV alcohol dependence. Logistic regression models were used to estimate the odds of relapse among asymptomatic risk drinkers and low-risk drinkers relative to abstainers, adjusted for a wide range of potential confounders.

RESULTS: By Wave 2,

• 51.0% of the Wave 1 asymptomatic risk drinkers had experienced the recurrence of AUD symptoms, compared with
• 27.2% of low-risk drinkers and
• 7.3% of abstainers.

Across all ages combined, the adjusted odds of recurrence of AUD symptoms relative to abstainers were

• 14.6 times as great for asymptomatic risk drinkers and
• 5.8 times as great for low-risk drinkers.

The proportions of individuals who had experienced the recurrence of dependence were 10.2, 4.0, and 2.9%, respectively, and the adjusted odds ratios relative to abstainers were 7.0 for asymptomatic risk drinkers and 3.0 for low-risk drinkers.

Age significantly modified the association between type of remission and relapse.

Differences by type of remission were not significant for younger alcoholics, who had the highest rates of relapse.

Abstinence represents the most stable form of remission for most recovering alcoholics

CONCLUSIONS: Abstinence represents the most stable form of remission for most recovering alcoholics. Study findings highlight the need for better approaches to maintaining recovery among young adults in remission from alcohol dependence, who are at particularly high risk of relapse.

Research; Dawson DA, Goldstein RB, Grant BF. Alcohol Clin Exp Res. 2007 Dec;31(12):2036-45. Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up.

Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence by William R. Miller Read more about this title…

Are Brief Alcohol Interventions Likely to be Effective in Routine Primary Care Practice?

A number of meta-analyses have demonstrated the modest efficacy of brief interventions (BI) for nondependent unhealthy alcohol use in primary care settings.

Whether this level of efficacy can be expected when BIs are delivered outside of research studies in not known.

This systematic review identified 22 randomized trials including over 5800 patients. Investigators classified the trials on a spectrum from tightly controlled (efficacy design) to real world (effectiveness design) studies.

The scale considered whether patients presented to health care with a range of conditions, whether practices delivered a full range of medical services, whether practitioners routinely worked in the service rather than being funded by the trial, and whether the intervention could be delivered within standard visit times.

• Participants who received BI drank approximately 3 standard drinks per week less than those who did not.
• Longer duration of intervention was not significantly associated with a larger effect.
• The effect of BI on drinking was similar in studies regardless of whether they were tightly controlled or had more real world characteristics.

Comments by Michael Levy, PhD

This meta-analytic study showed the benefit of BI in reducing alcohol consumption in both controlled and real world primary care settings.

It seems logical to assume similar results could be achieved in community treatment programs.

Since BI in the studies reviewed was designed to achieve a reduction in alcohol consumption, treatment programs could consider implementing BI for patients who are not interested in achieving abstinence but who want to reduce their intake.

Reference: Kaner EF, Dickinson HO, Beyer F, et al. The effectiveness of brief alcohol intervention in primary care settings: a systematic review. Drug Alcohol Rev. 2009;28(3):301–323.

From; Join Together Online

Predictors of changes in alcohol-related self-efficacy over 16 years

Self-efficacy is a robust predictor of short- and long-term remission after alcohol treatment. This study examined the predictors of self-efficacy in the year after treatment and 15 years later.

A sample of 420 individuals with alcohol use disorders was assessed five times over the course of 16 years.

Predictors of self-efficacy at 1 year included

• improvement from baseline to 1 year in heavy drinking,
• alcohol-related problems,
• depression,
• impulsivity,
• avoidance coping,
• social support from friends, and
• longer duration of participation in mutual-help Alcoholics Anonymous (AA).

Female gender, more education, less change in substance use problems, and impulsivity during the first year predicted improvement in self-efficacy over 16 years.

Clinicians should focus on

• keeping patients engaged in self-help of AA,
• addressing depressive symptoms,
• improving patient’s coping, and
• enhancing social support

during the first year and reduce the risk of relapse by monitoring individuals whose alcohol problems and impulsivity improve unusually quickly.

Research; Predictors of changes in alcohol-related self-efficacy over 16 years. John McKellar Ph.D, Mark Ilgen Ph.D., Bernice S. Moos B.A. and Rudolf Moos Ph.D. J Subst Abuse Treat. 2007 Nov 23.

See also;

• AA and Treatment Work Better Together
• Brief-TSF can assist patients cease alcohol consumption.
• AA Offers Recovery Not Religion

Drug and Alcohol Abuse: A Clinical Guide to Diagnosis and Treatment by Marc A. Schuckit Read more about this title…