Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: A 3-year follow-up
Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: A 3-year follow-up
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DOI：
10.1111/j.1530-0277.2007.00536.x
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发表时间：
2007-12-01
影响因子：
3.2
通讯作者：
Grant, Bridget F.
中科院分区：
文献类型：
--
作者：
Dawson, Deborah A.;Goldstein, Rise B.;Grant, Bridget F.
背景：在美国一般人群中，关于戒酒和非戒酒酒精依赖缓解的稳定性的信息很少。本研究的目的是检查DSM-IV酒精依赖缓解个体在3年内恢复状态的纵向变化，包括复发率和相关因素。方法：本分析基于全国酒精及相关疾病流行病学调查（NESARC）第1波和第2波的数据，这是一个具有全国代表性的18岁及以上的美国成年人样本，该样本最初于2001年至2002年接受采访，并于2004年至2005年再次接受采访。第一波NESARC确定了2109名符合DSM-IV标准的酒精依赖完全缓解的个体。其中，1772人在Wave 2进行了重新访谈，构成了本研究的分析样本。第2波的恢复状态作为第1波缓解类型的函数进行检查，重点关注复发率，交替定义为任何酒精使用障碍（AUD）症状的复发和DSM-IV酒精依赖的复发。使用逻辑回归模型来估计无症状风险饮酒者和低风险饮酒者相对于戒酒者的复发几率，并根据广泛的潜在混杂因素进行调整。结果：到第二波，51.0%的第一波无症状风险饮酒者经历了AUD症状的复发，相比之下，低风险饮酒者为27.2%，戒酒者为7.3%。在所有年龄段中，相对于不饮酒者，无症状风险饮酒者AUD症状复发的调整几率是无症状风险饮酒者的14.6倍，低风险饮酒者的5.8倍。复发依赖的个体比例分别为10.2%、4.0和2.9%，相对于戒酒者，无症状危险饮酒者的校正优势比为7.0，低危险饮酒者的校正优势比为3.0。年龄显著改变了缓解类型和复发之间的关系。在复发率最高的年轻酗酒者中，缓解类型的差异并不显著。结论：戒酒是大多数戒酒者最稳定的缓解形式。研究结果强调需要更好的方法来维持酒精依赖缓解的年轻人的恢复，他们复发的风险特别高。
Background: There is little information on the stability of abstinent and nonabstinent remission from alcohol dependence in the general U.S. population. The aim of this study was to examine longitudinal changes in recovery status among individuals in remission from DSM-IV alcohol dependence, including rates and correlates of relapse, over a 3-year period.Methods: This analysis is based on data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of U.S. adults aged 18 years and older originally interviewed in 2001 to 2002 and reinterviewed in 2004 to 2005. The Wave 1 NESARC identified 2,109 individuals who met the DSM-IV criteria for full remission from alcohol dependence. Of these, 1,772 were reinterviewed at Wave 2, comprising the analytic sample for this study. Recovery status at Wave 2 was examined as a function of type of remission at Wave 1, with a focus on rates of relapse, alternately defined as recurrence of any alcohol use disorder (AUD) symptoms and recurrence of DSM-IV alcohol dependence. Logistic regression models were used to estimate the odds of relapse among asymptomatic risk drinkers and low-risk drinkers relative to abstainers, adjusted for a wide range of potential confounders.Results: By Wave 2, 51.0% of the Wave 1 asymptomatic risk drinkers had experienced the recurrence of AUD symptoms, compared with 27.2% of low-risk drinkers and 7.3% of abstainers. Across all ages combined, the adjusted odds of recurrence of AUD symptoms relative to abstainers were 14.6 times as great for asymptomatic risk drinkers and 5.8 times as great for low-risk drinkers. The proportions of individuals who had experienced the recurrence of dependence were 10.2, 4.0, and 2.9%, respectively, and the adjusted odds ratios relative to abstainers were 7.0 for asymptomatic risk drinkers and 3.0 for low-risk drinkers. Age significantly modified the association between type of remission and relapse. Differences by type of remission were not significant for younger alcoholics, who had the highest rates of relapse.Conclusion: Abstinence represents the most stable form of remission for most recovering alcoholics. Study findings highlight the need for better approaches to maintaining recovery among young adults in remission from alcohol dependence, who are at particularly high risk of relapse.