Remission and Relapse in the General Population
Most studies investigating the course of alcohol use disorders involve clinical samples. In this study, researchers from the Netherlands studied the course in the general population. Using data from a cohort study on mental health, researchers analyzed the prevalence, remission, and relapse rates of alcohol use disorders over 3 years in 4214 people. Diagnoses were classified according to the Diagnostic and Statistical Manual IV (DSM-IV), International Classification of Diseases 10 (ICD-10), and the craving withdrawal model (CWM).*
- Rates of remission (full or partial) from baseline to the 3-year follow-up were high: 79%–92% for alcohol abuse/harmful use** and 69%–74% for alcohol dependence.
- Rates of relapse were low: 0%–14% of subjects with remitted alcohol abuse/harmful use or dependence at year 1 relapsed by year 3.
- About 1%–5% of subjects with alcohol abuse/harmful use at baseline developed dependence by year 3.
- Results did not significantly differ across the diagnostic classification systems.
Comments:
In a general population sample, alcohol use disorders have a favorable prognosis and may lack the chronic relapsing nature seen in treatment samples. These findings suggest that a substantial population of patients with alcohol use disorders could respond to brief or minimal interventions in primary care or other nonspecialty settings.
Peter D. Friedmann, MD, MPH
*An alternative classification that tries to address some potential disadvantages of the DSM-IV
**Harmful use is a classification in the ICD-10; it is similar to a DSM-IV diagnosis of alcohol abuse but does not include having alcohol-related social consequences as a criteria. For more information on alcohol definitions, see http://www.bu.edu/aodhealth/alcdefinitions.html.
Reference:
de Bruijn C, van den Brink W, de Graaf R, et al. The three year course of alcohol use disorders in the general population: DSM-IV, ICD-10 and the Craving Withdrawal Model. Addiction. 2006;101(3):385–392.