Patterns of alcoholism over four years.

Abstract

Men alcoholics, randomly selected from patients admitted to 8 alcoholism treatment facilities in 7 states, were followed up at 18 mo. and 4 yr after admission. At admission the median age of the 758 men was 46 and 63% were unemployed. Follow-up data were obtained on 85% of the sample. At 4 yr 15% had died, a rate of 2.5 times that expected; 56% of the deaths were alcohol related. Of the survivors at 4 yr, 46% were in remission: 28% were classified as long-term abstainers (6 mo. or more) and 18% as nonproblem drinkers (having no dependence symptoms or adverse consequences of drinking in the previous 6 mo.). The remainder, 54%, were classified as problem drinkers. The prognoses for short-term abstainers (those abstaining for less than 6 mo.) and for drinkers showing dependence symptoms were considerably more unfavorable than for the 2 remission groups. Although the 2 remission groups were approximately equivalent in levels of social adjustment, mental health and physical condition, results at 4 yr showed only modest improvements in adjustment. Analysis of change between 18 mo. and 4 yr revealed that patterns of relapse for nonproblem drinkers vs. abstainers varied substantially among different subgroups of alcoholics. Among patients over age 40 and highly dependent on alcohol at admission, relapse rates were higher for nonproblem drinkers than for abstainers. Among patients under age 40 and less dependent on alcohol at admission, relapse rates were lower for nonproblem drinkers than for long-term abstainers. The heterogeneity of alcoholics and the importance of age and level of alcohol dependence in affecting processes of remission and relapse were indicated.