Which Alcoholics Are Most Likely to Relapse?
Alcohol use disorder (AUD) is the diagnosis that doctors in the U.S. use to identify separate or overlapping symptoms of non-addicted alcohol abuse and alcoholism. Significant numbers of people diagnosed with this condition will experience a relapse at some point after entering recovery. In a study published in April 2014 in the journal Drug and Alcohol Dependence, a team of Dutch researchers used a long-term project to determine if it’s possible to predict which individuals recovering from alcohol use disorder have the highest chances of relapsing. These researchers uncovered several factors that act as potential relapse indicators for any given person.
Alcohol Use Disorder
People affected by alcoholism often have symptoms normally associated with non-addicted alcohol abuse. At the same time, people affected by non-addicted alcohol abuse can have some of the symptoms associated with alcoholism. The alcohol use disorder diagnosis, created by the American Psychiatric Association in 2013, officially accounts for the overlapping effects of these two alcohol-related conditions by giving doctors the ability to count the number of alcohol abuse symptoms and alcoholism symptoms present in their patients, rather than treating these symptoms as separate issues. Altogether, a person affected by alcohol use disorder can have as many as 11 alcohol abuse/alcoholism symptoms. Depending on the number of symptoms present, doctors make a diagnosis of mild AUD (two or three symptoms), moderate AUD (four or five symptoms) or severe AUD (six or more symptoms).
Upon entering recovery, a person diagnosed with alcohol use disorder commonly goes through a detoxification period where he or she stops drinking and experiences the elimination of alcohol from the brain and body. In people with a physical dependence on alcohol, this detoxification period typically triggers the symptoms of alcohol withdrawal, which can range in intensity from merely unpleasant to severe or even life-threatening. One of the most frequent symptoms of alcohol withdrawal is a strong craving to return to active alcohol consumption. Even after withdrawal ends and a client/patient goes on to the next steps of the recovery process, alcohol cravings can remain in a persistent, powerful form. In addition, a recovering drinker can encounter situations or events that, in the past, acted as conscious or unconscious cues for alcohol intake. These cues usually remain active after the initial establishment of abstinence, and they can have a potent psychological and physical impact.
Who Has the Highest Risk?
In the study published in Drug and Alcohol Dependence, researchers from the Netherlands Institute of Mental Health and Addiction, Utrecht University and the University of Amsterdam used information from a long-term project called the Netherlands Mental Health Survey and Incidence Study-2 to analyze the factors most likely to contribute to relapse in a person recovering from alcohol use disorder. All told, 506 people took part in this analysis. Each of these individuals had previously received an alcohol use disorder diagnosis; however, at the beginning of the study, none of them had qualified for a diagnosis of the disorder for at least a year. In some cases, the participants had not consumed alcohol for decades. Three years after the study began, the researchers examined all of the participants and used a detailed interview to establish each person’s current pattern of alcohol intake and determine if a relapse back into diagnosable alcohol use disorder had occurred.
The researchers concluded that only a small number of the study participants experienced a relapse during the three-year interval under consideration. Factors tied to an increased chance of experiencing a relapse were having a “medium” or “high” level of weekly alcohol consumption before initially receiving an alcohol use disorder diagnosis, having at least six symptoms of alcohol use disorder over the course of a lifetime, having an impaired ability to limit alcohol intake and having a current level of alcohol consumption that exceeds the commonly accepted guidelines for moderate alcohol intake. The study participants with the highest risks for experiencing a relapse back into fully diagnosable AUD currently drank in more than moderate amounts and also had either a past history of medium- or high-alcohol intake, or a lifetime history of six or more alcohol use disorder symptoms.
It’s important to note that the “medium” and “high” levels of intake reported by the study’s authors exceeded established guidelines for moderate, relatively safe alcohol consumption. In light of their findings, the authors believe that current drinking levels may be enough on their own to help doctors identify those people most likely to relapse after receiving treatment for alcohol use disorder.