Abstinence best for recovering alcoholics

Complete abstinence from drinking offers alcoholics the best chance of a lasting recovery -- though it may not work as well for the youngest alcoholics, a U.S. government study suggests.

In a study that followed nearly 1,800 alcoholics over 3 years, researchers found that those who abstained from alcohol were less likely to suffer a relapse than those who had only cut their drinking to modest levels.

At greatest risk were those who were no longer suffering symptoms of alcoholism at the beginning of the study, but were still drinking fairly heavily.

Lead author Dr. Deborah Dawson of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and her co-authors also found that the chances of lasting success with abstinence varied by age. Among alcoholics younger than 25, abstainers were no more likely to stay in remission than those who were still drinking heavily at the study's start.

The findings suggest that young alcoholics need more help in achieving a lasting recovery, Dawson and colleagues report in the journal Alcoholism: Clinical and Experimental Research.

The study included a nationally representative sample of U.S. adults who, at the outset, were in remission from alcohol dependence. Just over 38 percent had completely stopped drinking. A similar percentage were considered "low-risk" drinkers; they were free of alcoholic symptoms - such as craving and physical withdrawal symptoms when they weren't drinking -- but were drinking at moderate levels.

The rest were free of alcoholic symptoms but were still drinking at levels believed to put them at high risk of relapse -- 14 or more drinks per week for men, or 7 or more for women.

Three years later, 1,772 study participants were interviewed again. Half of the high-risk drinkers had an occurrence of some alcohol abuse symptoms, while 10 percent had relapsed into full-blown alcohol dependence. The corresponding figures for the abstainers were just 7 percent and 3 percent.

Among low-risk drinkers, 27 percent reported some symptoms of alcohol abuse, while 4 percent had relapsed.

When the researchers looked at the group by age, however, they found that alcoholics younger than 25 had the most difficult time with long-term recovery -- even if their chosen route was abstinence.

Nearly 30 percent of young abstainers were suffering alcohol abuse symptoms 3 years later, and almost 12 percent had relapsed into dependence.

"The first thing we can take from these findings is that we need to learn a lot more about the best treatment approaches for younger patients," said Dr. Mark L. Willenbring, director of treatment and recovery research at the NIAAA.

Most alcoholism treatment studies have been in middle-aged adults, he told Reuters Health, because the youngest alcoholics are typically not the ones who seek treatment.

According to Willenbring, who was not involved in the study, researchers need to find ways to reach out to younger alcoholics where they are -- on college campuses, for example, or in emergency rooms after a binge.

One key obstacle to successful treatment, Willenbring noted, may be the context in which young alcoholics drink. Whether they are in college or not, young adults' social life often centers on bars and drinking, he pointed out. Younger patients may need more help in dealing with these social influences.

SOURCE: Alcoholism: Clinical and Experimental Research, December 2007.