Recovery from DSM-IV Alcohol Dependence: United States, 2001-2002

Aims: To investigate the prevalence and correlates of recovery from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol dependence by examining the past-year status of individuals who met the criteria for prior-to-past-year (PPY) dependence. Design: Cross-sectional, retrospective survey of a nationally representative sample of U. S. adults age 18 and older (first wave of a planned longitudinal survey). Methods: This analysis is based on data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), in which data were collected in personal interviews conducted with one randomly selected adult in each sample household. A subset of the NESARC sample (total n = 43,093), consisting of 4,422 U. S. adults age 18 and older classified with PPY DSM-IV alcohol dependence, were evaluated with respect to their past-year recovery status: past-year dependence, partial remission, full remission, asymptomatic risk drinking, abstinent recovery (AR), and nonabstinent recovery (NR). Correlates of past-year status were examined in bivariate analyses and using multivariate logistic regression models. Findings: Of people classified with PPY alcohol dependence, 25.0 percent were still classified as dependent in the past year; 27.3 percent were classified as being in partial remission; 11.8 percent were asymptomatic risk drinkers who demonstrated a pattern of drinking that put them at risk of relapse; 17.7 percent were low-risk drinkers; and 18.2 percent were abstainers. Only 25.5 percent of people with PPY dependence ever received treatment. Being married was associated positively with the odds of both AR and NR, and ethanol intake was negatively associated with both. Severity of dependence increased the odds of AR but decreased the odds of NR. The odds of AR (but not NR) increased with age and female gender but were decreased by the presence of a personality disorder. Treatment history modified the effects of college attendance/graduation, age at onset, and interval since onset on the odds of recovery. Conclusions: There is a substantial level of recovery from alcohol dependence. Information on factors associated with recovery may be useful in targeting appropriate treatment modalities. KEY WORDS: Dependence, natural recovery, remission, recovery, risk drinking. INTRODUCTION Studies of general population samples have demonstrated substantial levels of recovery from alcohol depen-dence, often without benefit of formal or self-help (e. g., 12-step) treatment and culminating frequently in asymptomatic drinking (often termed nonabstinent recovery or controlled drinking) rather than in abstinence (Fingfeld 1997; Tucker 2003). Even among treatment samples that have been followed over time, rates of recovery are far from neg-ligible, although nonabstinent recovery is rare. Reports of the extent, type, and correlates of recovery have varied accord-ing to various study-level factors, as follows: 1 Although recovery is generally defined as meeting the diagnostic criteria for full remission of alcohol use disorders, recovery rates are lower when they exclude people whose consumption puts them at risk of relapse. 2 Clinical samples tend to result in lower recovery rates than population samples because they include more severely dependent individuals and exclude those who were able to recover without treatment. 3 Recovery rates are likely to be higher (and less often associated with alcohol treatment) if the baseline populationcomprises less severely affected individuals-for example, those withabuse, or "problem drinkers," ratherthan just individuals with alcohol dependence. 4 Studies based on individuals with lifetime dependence have lower recovery rates than those based on individuals with prior-to-past-year (PPY) dependence, in that people with a past-year onset of dependence are by definition precluded from estimates of past-year recovery. …