Systematic review of untreated remission from alcohol problems: Estimation lies in the eye of the beholder

Abstract

BackgroundRemission from alcohol problems in the absence of treatment is common, yet there are wide ranging estimates of the extent to which this occurs, depending on method. A systematic review of the literature on untreated remission from alcohol problems was conducted to analyse the ways different definitions and study designs impact on estimates of untreated remission from alcohol problems, and to explore the implications for treatment planning. Methods2103 texts were identified through systematic searches of databases (Medline, PsycINFO, EMBASE) and other searches. Peer-reviewed journal articles published since 1975 which provided numeric estimates of untreated remission from alcohol problems were included. A narrative synthesis was undertaken. Results124 estimates of untreated remission from alcohol problems were extracted from 27 studies. Three different sampling methods were identified: taking an ‘alcohol problems sample’ (method 1) which estimated the proportion of people with alcohol problems who remit without treatment; taking an ‘untreated sample’ (method 2) which estimated the proportion of untreated people who enter remission; and taking a ‘remitted sample’ (method 3) which estimated the proportion of people in remission who have not received treatment. In addition to this sampling diversity, the definitions of an alcohol problem, definitions of remission, and definitions of treatment varied between studies. The combination of the methods and definitional issues impacted on estimates of untreated remission from alcohol problems. ConclusionsEstimates derived from the ‘alcohol problems sample’ (method 1) and ‘untreated sample’ (method 2) are the most appropriate for treatment planners. How a treatment planner defines what treatment is, what remission is, and how an alcohol problem is defined all matter for these estimates.