Print Friendly
Predictors of Sustained Remission from Alcohol Use Disorder
In Session With Ryan S. Trim, PhD:
Predictors of Sustained Remission from Alcohol Use Disorder
Assistant Professor, Department of Psychiatry, University of California, San Diego; Clinical Psychologist, VA San Diego Healthcare System, San Diego, CA
First published in Psychiatry Weekly, Volume 8, Issue
9, on April 22, 2013
Q: What do we really know about predictors of recovery from alcohol-use disorders (AUDs)?
A: Many studies describe how people can get into a problematic cycle of drinking, including more severe levels of abuse and dependence. Such studies have found a wide range of risk factors related to both genetics and the environment. However, we know less about how people get out of that cycle, because there are fewer good studies on this subject.
Fortunately, Dr. Marc Schuckit has collected data on a group of men for over 30 years,1 providing unique insight into how individual drinking patterns change across time, particularly for those who were at risk for alcohol problems earlier in life. Dr. Schuckit’s exemplary longitudinal study included 453 drinking male subjects without an AUD at baseline, half of whom had an alcoholic father. For the current analysis,2 we selected a subsample of individuals who met criteria for an AUD by ~30 years of age (n=129), and examined their rates of AUD remission over the following ~20 years.
Q: What were the main characteristics and predictors of AUD remission, sustained or otherwise?
A: We found that a majority of these men (~60%) met criteria for at least one 5-year period of remission during the 20-year follow-up period, and 45% met criteria for sustained remission (ie, they did not meet AUD criteria again subsequently).
Lower drinking frequency, more education, and having alcohol abuse (versus dependence) at age 30 were predictors of AUD remission. Participation in formal alcohol treatment by age 30 was also associated with sustained AUD remission.
An interesting component of Dr. Schuckit’s work explores the “level of response” (LR) to alcohol. For those who require a lot of alcohol to feel an effect early in life (a genetically influenced trait), Dr. Schuckit has found that this trait predicts an elevated risk for heavy drinking and alcohol problems. Individuals with this low LR to alcohol typically associate with heavier-drinking peers, are more likely to use alcohol to cope with stress, and have more positive expectancies for alcohol use. This study found that, among men who developed an AUD by age 30, a low LR to alcohol predicted sustained AUD remission, possibly due to the low association of this trait with other substance use and psychiatric disorders.
Overall, I think this research highlights the complexity of recovery from AUD and the utility of screening for any sort of alcohol use disorder, regardless of age. While many people can get better without formal alcohol treatment, we do know that formal treatment (the sooner the better) can be helpful for people struggling with alcohol problems. This study helps us see how this process unfolds over time, and the next step is to examine these patterns in other clinical and at-risk samples.
Disclosure: This work was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (Grant #AA05526) awarded to Dr. Schuckit; and by a grant from the Alcoholic Beverage Medical Research Foundation (ABMRF)/ The Foundation for Alcohol Research awarded to Dr. Trim.
Reference:
1. Schuckit MA, Gold EO. A simultaneous evaluation of multiple markers of ethanol/placebo challenges in sons of alcoholics and controls. Arch Gen Psychiatry. 1988;45:211-216.
2. Trim RS, Schuckit MA, Smith TL. Predictors of initial and sustained remission from alcohol use disorders: findings from the 30-year follow-up of the San Diego Prospective Study. Alcohol Clin Exp Res. 2013 Mar 4. doi: 10.1111/acer.12107. [Epub ahead of print]