Problem-free drinking over 16 years among individuals with alcohol use disorders

Abstract

Background Limited data exist on the rates and long-term stability of non-problem drinking in individuals who sought help for an alcohol use disorder. Methods A sample of initially untreated individuals with alcohol use disorders ( n = 420) was surveyed at baseline and 1 year and was re-assessed at 8 and 16 years. Results In the 6 months prior to the 1-year assessment, 36% ( n = 152) of participants reported abstinence from alcohol, 48% ( n = 200) reported drinking with problems, and 16% ( n = 68) reported non-problem drinking. At each follow up, 16–21% of the sample reported non-problem drinking. Compared to individuals in the abstinent and problem-drinking groups, individuals who were drinking in a problem-free manner at 1 year had reported, at baseline, fewer days of intoxication, drinks per drinking day, alcohol dependence symptoms, and alcohol-related problems, less depression, and more adaptive coping mechanisms. Over time, 48% of participants who engaged in non-problem drinking at 1 year continued to report positive outcomes (either non-problem drinking or abstinence) throughout the long-term follow-up, whereas 77% of those abstaining at 1 year reported positive outcomes throughout the same time period. Additionally, 43% of individuals with problematic alcohol consumption at 1 year reported positive outcomes over the remaining follow-up interval, a rate that was not significantly different from the rate of positive outcomes of 48% observed in those with initial problem-free drinking. Conclusions Although some individuals report non-problem drinking a year after initially seeking help, this pattern of alcohol use is relatively infrequent and is less stable over time than is abstinence. An accurate understanding of the long-term course of alcohol use and problems could help shape expectations about the realistic probability of positive outcomes for individuals considering moderate drinking as a treatment goal.