STABILITY OF REMISSION FROM ALCOHOL DEPENDENCE WITHOUT FORMAL HELP

Alcohol & Alcoholism Vol. 41, No. 3, pp. 311–314, 2006 Advance Access publication 20 February 2006 doi:10.1093/alcalc/agl008 STABILITY OF REMISSION FROM ALCOHOL DEPENDENCE WITHOUT FORMAL HELP HANS-JÜRGEN RUMPF1*, GALLUS BISCHOF1, ULFERT HAPKE2, CHRISTIAN MEYER2 and ULRICH JOHN2 1 Department of Psychiatry and Psychotherapy, Research Group S:TEP, University of Lübeck, Lübeck and 2Institute of Epidemiology and Social Medicine, Addiction Research Center, University of Greifswald, Greifswald, Germany (Received 19 April 2005; first review notified 16 June 2005; in revised form 17 January 2006; accepted 17 January 2006; advance access publication 20 February 2006) Abstract — Aims: To determine the stability of remission from alcohol dependence without formal help. Methods: In a cohort of untreated remitters, a follow-up after 24 months was conducted. Participants were recruited through media solicitation and via a general population study. At baseline, all participants (n = 144) fulfilled criteria of remission from alcohol dependence for the previous 12 months without prior use of formal help (sustained full remission according to DSM-IV, neither inpatient nor outpatient treatment, no more than two self help group meetings). Personal interviews were conducted using standardized instruments. Results: In the followup period, four individuals died; 92.9% of the remaining participants were re-interviewed (n = 130). Of those interviewed 92.3% showed stable remission without formal help, 1.5% were currently alcohol dependent according to DSM-IV, 1.5% were classified alcohol dependent on grounds of collateral information, 1.5% fulfilled one or two criteria of dependence, and 4.6% utilized formal help. Conclusions: Untreated remission is not a transient phenomenon. Therefore, studying remitters from alcohol dependence without formal help can yield valid information on pathways to recovery. INTRODUCTION dependence. The more in-depth studies on ‘natural recovery’ have been cross-sectional. One study gives some evidence on stability in untreated alcohol dependent individuals: Hasin, Liu and Paykin (Hasin et al., 2001) found that in a 12-monthfollow-up, the probability of sustained reduction in drinking among the group with baseline alcohol dependence was as high as in subjects without dependence. To assess the value of the in-depth cross-sectional studies on ‘natural recovery’ that have been conducted so far, it is worthwhile to know how stable untreated remissions are; however, such data are missing. It might be argued that remitters without formal help have frequent relapses or utilize treatment in the long run. The first argument is underlined by the finding that periods of abstinence are quite common among alcoholdependent individuals: periods of abstinence lasting at least 3 months were reported by 62.3% (Schuckit et al., 1997). The present study adds knowledge to the field by providing longitudinal data from a sample of untreated remitters from alcohol dependence. The aim is to analyse the stability of remission without formal help. Most knowledge on the course of and the remission from alcohol dependence is based on research with individuals undergoing treatment. The groundbreaking long-term study by Vaillant (1982) revealed that a substantial proportion of alcohol dependent individuals recover without treatment. This has been confirmed by other longitudinal studies (Hasin et al., 1997; Booth et al., 2001) with one study showing that within a period of 4 years 39.4% remitted from alcohol dependence, 14.7% had alcohol abuse and the remaining 46% were still alcohol dependent (Hasin et al., 1990). Crosssectional epidemiological studies based on representative general population samples confirmed that only a minority seeks professional help (Grant, 1997), and among those who remit the majority do so without formal help (Dawson, 1996; Sobell et al., 1996). A recent study showed that among those who recovered only 25.5% ever received treatment (Dawson et al., 2005). Studying this predominant group could enlarge our knowledge on the process of remission and give valuable suggestions for treatment. However, research in this field is, firstly, rather rare and, secondly, often based on cross-sectional analyses, (e.g. Tuchfeld, 1981; Klingemann, 1991; Sobell et al., 1993; Tucker et al., 1994; Cunningham, 1999). Most longitudinal studies on untreated alcohol dependent individuals (Vaillant, 1982; Leung et al., 1993; Vaillant, 1996; Öjesjö et al., 2000) are of limited number and show restrictions in at least one of three aspects: (i) in all available studies, samples were not confined to alcohol dependence alone. The criterion ‘alcoholism’ was used which covers both dependence and abuse. (ii) Samples consisted of subgroups such as men (Vaillant, 1996; Öjesjö et al., 2000) or native Americans (Leung et al., 1993). (iii) Subjects seeking some kind of formal help (e.g. addiction treatment or Alcoholics Anonymous) were not excluded. In addition, most of these studies have investigated a rather small number of variables related to the course or the process of remission from alcohol METHODS The data are part of the project Transitions in Alcohol Consumption and Smoking (TACOS) (Rumpf et al., 1998). More details on the cross-sectional part of this study can be found elsewhere (Bischof et al., 2000a, b; Bischof et al., 2001; Bischof et al., 2002; Rumpf et al., 2002; Bischof et al., 2003). Remission without formal help was defined as meeting DSM-IV (American Psychiatric Association, 1995) or ICD-10 (WHO, 1991) criteria of alcohol dependence during lifetime but not within the last 12 months; participants fulfilled DSM-IV remission specifiers of sustained full remission (meeting none of the dependence criteria for at least 12 months). This criterion was applied in order to be in line with other studies on natural recovery from alcohol dependence. In a review, the median of the minimum required recovery length was 12 months (Sobell et al., 2000). In addition, subjects did not fulfill criteria for alcohol *Author to whom correspondence should be addressed at: Tel.: +451 5002871; Fax: +451 5003480 or 5002603; E-mail: 311 Ó The Author 2006. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved 312 H.-J. RUMPF et al. abuse. To meet our criteria of remission without formal help, participants were not included if they utilized some kind of addiction treatment lifetime; following the criteria of Sobell et al. (1993), attending up to two self-help group (AA or other) meetings (6.9% of our sample) was not considered as formal help. In addition, participants receiving psychotherapy of comorbid psychiatric disorders within 2 years prior and 1 year after remission, were excluded. In 87%, collateral interviews could be conducted to confirm data according to the alcohol dependence syndrome, utilization of formal help, date of remission and alcohol (...truncated)