There were several significant (P <.05) differences in responses between the subjects with alcohol abuse in remission and those with dependence in remission. Those with dependence in remission more frequently made conscious decisions to modify their drinking. The previously dependent subjects more frequently reported discrete events that precipitated attempts to modify their drinking, cited emotional concerns as an impetus to modify their drinking, wanted to change their lives, found helpful strategies for modifying their drinking, and experienced circumstances that helped them to quit or cut down. They more frequently had help from nonprofessionals, professionals, formal alcohol treatment programs, and self-help groups, such as Alcoholics Anonymous. Although the dependent subjects were more likely than the abusing subjects to make rules about their drinking (23 of 59, 38.9% vs 16 of 60, 26.6%) and aim for abstinence (27 of 59, 45.7% vs 18 of 60, 30.0%), the differences between the dependent and abusing subjects were not statistically significant. More than half (32 of 59, 54.2%) of the subjects with alcohol dependence in remission did not attempt abstinence.
There were some statistically significant differences between the 16 previously dependent subjects who had received formal treatment and the 43 who had not. Those who had received treatment more frequently attempted abstinence, attempted strategies that were not helpful, found others helpful in modifying their drinking, and attended self-help groups. Those who had received treatment more frequently cited family and emotional issues, but not medical, legal, financial, work, or social issues as contributing to their desire to modify their drinking. There were no statistically significant differences in the frequency with which the subjects in these 2 groups made conscious decisions to modify their drinking, made rules about their drinking, experienced discrete events that precipitated efforts to modify drinking, wanted their lives to go differently, found helpful strategies to modify their drinking, found circumstances that helped or hindered modification of drinking, or returned to previous levels of drinking. Similar comparisons could not be made for the subjects with alcohol abuse in remission, because only 3 of those 60 subjects had received formal treatment.
Discussion
We found a high prevalence (30.9%) of alcohol problems in remission. Other studies have shown that the prevalence of current alcohol dependence, alcohol abuse, and risky but not problematic drinking is also substantial.4,13 Although patients with alcohol issues may not seek or may avoid specialized treatment, they frequently return to primary care settings for a variety of medical issues. Thus, as others have concluded,1,19-22 primary care settings offer clinicians opportunities to intervene for patients with AUDs or risky drinking behaviors.
Strengths and limitations
There are some potential limitations to our study. The 76.8% response rate raises concern about whether the subjects were representative of the entire target population. Although the participants and the nonresponders were similar in demographic attributes and in alcohol-related diagnoses, they might have provided different responses to the more substantive questions of the interview. There is also the possibility that the self-reports were not always accurate. Although the interviewers were trained to project neutrality and general support, a socially desirable response set might have been operative. For some subjects, the long period of time between the onset of their remission and the interview might have reduced the accuracy of their responses. Also, we only sampled individuals who were currently in remission, elucidating factors that may have facilitated remission. We did not explore the impact of such factors on individuals who were not in remission.
The generalizability of the prevalence of AUDs in remission may be limited, because our study was conducted in Wisconsin, a state with particularly high levels of alcohol consumption. The generalizability of other findings may be limited, because the study sample was fairly affluent and well educated and because there were 2 eligibility screenings-one for the original screening study and another for our study.
The strengths of our study include subjects sampled from a general primary care population; other studies used mass media recruiting or convenience sampling.5-12 Also, we used a standard validated instrument to assess alcohol problems, while others used less accurate screening tools.5,6,11,12
Nevertheless, our results agreed with previous studies that many patients with alcohol abuse or dependence can remit without formal alcohol treatment. The potential for spontaneous remission appears to be particularly strong for young adults who experience growth in their families and career demands. However, other research suggests that many middle-aged alcohol-dependent men may experience remission without treatment.23 A substantial number of dependent patients in the sample attained remission despite continued moderate drinking, with remission defined as cessation of the negative consequences of drinking. This result stands in stark contrast to the opinion, espoused by Alcoholics Anonymous and held by many substance abuse treatment professionals, that the vast majority of alcohol-dependent patients can never drink safely again. One possible explanation for this discrepancy may be a difference in case-mix of alcohol-dependent patients in specialized alcohol treatment settings and primary care settings. If predisposition for alcohol dependence is truly polygenic as is suspected,3 one would expect alcohol dependence to occur with varying severity. In primary care settings, alcohol dependence may be less severe and more amenable to self-treatment than in specialized alcohol treatment settings. Thus, in primary care settings, attempts to reduce drinking to safer levels, rather than insistence on abstinence, may be an appropriate initial therapeutic approach for alcohol-dependent patients who do not have serious alcohol-related medical problems. At follow-up, those dependent patients who cannot moderate their drinking or remain free of alcohol-related problems would then be advised to abstain.