silentrun

Ran across an interesting read. Here is the link
Five Years Is Magic Number for Recovering Alcoholics

Five Years Is Magic Number for Recovering Alcoholics

Attempts at social drinking frequently lead to relapse
By William J. Cromie

Gazette Staff

Harvard alumni and others who became alcoholics were not likely to return to drinking if they remained sober for five years, according to a Medical School study.

In the longest investigation to date, researchers tracked 268 Harvard graduates and 456 poor, inner-city men from adolescence to age 60-70 years. While the economically disadvantaged drinkers were more likely to become alcoholics, they were twice as likely as the college men to kick the habit. By age 60, 59 percent of the Harvard group still abused alcohol, compared to 28 percent of the inner-city men.

Forty percent of those who managed only two years of abstinence eventually went back to the bottle.

"After five years of sobriety, however, relapse was rare," notes George Vaillant, professor of psychiatry, who headed the research. "Before this study no one knew how long an alcoholic has to be sober to be cured."

The study concludes that it is difficult, if not impossible, for men who abuse alcohol to return to social drinking. "Of 21 men who returned to social drinking after age 40, all but five relapsed before they went five years without abusing alcohol," Vaillant noted.

"Liberal-minded people are upset by the idea that Alcoholics Anonymous (AA) and other groups insist you must remain abstinent," Vaillant said "It's an ongoing controversy, but this study supports the AA point of view. If you follow former abusers long enough, you see that most of the social drinkers relapse."

Education Doesn't Help

Vaillant, who directs psychiatric research at Brigham and Women's Hospital, took over the study 30 years ago after the men had already been tracked for 25 years. He found that the Harvard men began alcoholic abuse later than the poor, inner-city males and experienced fewer problems.

"Socially disadvantaged men, in part as a function of early onset of severe alcohol dependence, often become stably abstinent," Vaillant explained. "However, because of poor health habits (especially smoking and diet) they are more likely to die [sooner].

"On the other hand, alcohol abusers with excellent social supports, high education, good health habits, and late onset of alcohol abuse are more likely to survive and to maintain a pattern of lifelong intermittent alcohol abuse. Thus, the college men, despite their educational and social advantages, were less likely to abstain from alcohol abuse."

By age 60, 18 percent of the Harvard alcohol abusers had died, compared to 29 percent of inner-city men. Thirty-two percent of the latter group were abstinent compared to 11.5 percent of the college men.

Surprisingly, after 5 to 15 years of worsening symptoms, the severity of alcoholism leveled off. "After age 40, instead of progressing, it is rather like chronic obesity -- it doesn't get better, it doesn't get worse," Vaillant commented.

Alcohol, directly or indirectly, kills 100,000 people in the United States each year, according to the study, published in the March issue of Archives of General Psychiatry. Also, the risk of heart disease and cancer is twice as high for alcohol abusers than for nonabusers, and heavy smoking dramatically increases the death rate among abusers.












Copyright 1998 President and Fellows of Harvard College

caboblanco

I don't know... there are studies that show that a lot of problem drinkers that moderate successfully...a question would be..how much drinking is considered a problem or dysfunctional?..if you take a study of people that sought help on their own or were legally forced to vs..people that just fit a criteria of alcohol abuse but feel they

can fix the problem on their own...you are going to get different results...like on here maybe 1% of people feel moderation is possible for any problem drinker ever...but we are not a microcasm of problem drinkers in the rest of society...and it is "sober" recovery after all

silentrun

Only you can answer that for you. I know that the more I get the more I want. No question about that for me. Are you questioning that for you Cabo? I know others have said they spent time looking for a door 3. I only saw door 1 "all in" and door 2 "all out". Even the fact that someone would look for a door 3 signals a problem. Someone without that little gremlin in their head would just be happy to get out alive.

caboblanco

No ..once i got a fatty liver that was the end for me. the thing is the people who moderate...you won't hear from them..and there is the old thing that if you can moderate you were not an alcoholic...so I guess you were just an amateur alcoholic then...we have our pecking order

awuh1

Interesting study. It generally fits with my experience. The main problem I have with the article is that the term “alcoholic”, alcohol abusers” and those who exhibit “alcohol dependence” seem to be talked about as if they are the same.

AA's definition of alcoholic, for example, has the idea that one drink triggers the urge to have more drinks, or as AA likes to say, the first drink triggers the “phenomenon of craving”. This is not addressed in the DSM diagnostic categories. It is also considered far less often in academic circles than it should be.

A penny for your thoughts EndGameNYC

silentrun

Glad you are not thinking of it for you Cabo. I don't think the people who can moderate really care what anyone else says about it. If they can then they do. I like that amateur alcoholic. There is no way I could handle the big league.

caboblanco

no the people that moderate are amateur alcoholic..we are in the big leagues

EndGameNYC

Happy to help.

There's been a lot of discussion and controversy among professionals since the recent publication of the DSM-V with regard to the use of alcohol and other substances. In DSM-IV, "Alcohol Abuse" and "Alcohol Dependence" were two separate categories, with dependence aligning with the common usage of 'alcoholism'.

Substance abuse in DSM-IV requires fewer criteria to meet the diagnosis than does dependence, and includes significant subjective distress (emotional pain) in order to meet the diagnosis. Abuse criteria together reflect impairments in social and interpersonal functioning, legal problems and a failure to successfully complete role expectations (e.g., work, school, home), and drinking in potentially hazardous situations, such as driving while drunk. It closely aligns with what people sometimes refer to as "periodic binge drinking," over a period of at least twelve months.

Dependence in DSM-IV generally includes tolerance and/or withdrawal in order to render the diagnosis. And though the criteria for dependence and withdrawal are not required to meet the diagnosis, it's very rare that people who meet the other criteria for dependence don't also have either tolerance or withdrawal.

The phenomenon of craving is not dealt with directly in either version of the DSM, but is subsumed among three of the last four DSM-IV criteria:

"The substance is often taken in larger amounts or over a longer period than was intended."

"There is a persistent desire or unsuccessful efforts to cut down or control substance use."

"A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects."

"The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance."

Abuse is discarded in DSM-V (as is the "legal problems" criterion), and both categories of abuse and dependence, as well as their criteria, are virtually combined in "Alcohol Use Disorder" with the following qualifiers: 'mild', 'moderate', and 'severe'.

For well-trained and well-practiced clinicians and researchers, the diagnosis is fairly straightforward. Much of the debate among professionals comes from people who rely on research grants for their work, and honest researchers who want to ensure the integrity of their work. It's been my experience that people who volunteer to participate in studies about alcoholism or other addictions are generally honest in their accounts.

For those in clinical treatment, the measure of a person's involvement in alcohol use and it's accompanying problems often emerges over time, with most people minimizing their intake and problems caused by their drinking during their initial consultation and for some time afterwards.

In reality, very few people voluntarily seek treatment of any kind for problems with alcohol, and fewer still attempt to access therapists or addiction counselors. Those who do land in therapy rarely stay for more than a couple of months or more.

ScottFromWI

I cannot moderate, and I've never met an alcoholic that was ever able to return to moderation. No matter what any studies say, I don't ever plan on drinking again. I will advise other alcoholics to do the same.

awuh1

Thanks EG, I always value your input with regard to research articles.

This might be a little off topic, but it seems to me that many studies (this one included) may be studying somewhat different patterns of alcohol use, and therefore different patterns of recovery.

What I'm getting at is the distinction between the person who cannot have just one drink without triggering the phenomenon of craving, as opposed to the individual who just continues to drink more and more over a given length of time, but without experiencing that phenomenon of craving. I believe that the latter can cross a line, so to speak, and turn into the former, but that the reverse is never true.

I think this makes for unclear results in many studies that suggest that some 'alcoholics' can moderate their drinking, when (I suspect) it is these folks who are the ones that never experienced the phenomenon of craving.

This can then damage individuals who think that they can someday drinking normally, when in fact there is no hope of that (IMO). My thinking is that more clear diagnostic criteria, which takes this into account, based on research that does likewise, could improve our understandings of the nature of the beasts as well as its their clinical treatment.

Just my 2 cents

Dee74

I think it's also important to remember the historic specificity of this study
D

silentrun

I read it to support that moderation does not work.

"Liberal-minded people are upset by the idea that Alcoholics Anonymous (AA) and other groups insist you must remain abstinent," Vaillant said "It's an ongoing controversy, but this study supports the AA point of view. If you follow former abusers long enough, you see that most of the social drinkers relapse."

caboblanco

i'm sober but I'm not threatened if it's possible for a problem drinker to moderate and i don't try to predict his outcome either...I'm also not threatened by people who think it's impossible for problem drinkers to moderate..I don't now the truth on that..i would guess that there are drunks that can and drunks that cannot ...I don't know if this study made up it's point of view before it got back the results..since they seemed they needed to bash "liberal-minded" people...but I find that to be the case often...politics..not science

enfinthechange

Hello, hope you don't mind my interjection... it may be that more educated people are more able to cope with their alcoholism and rationalise it within their secure homes and lives... so their alcoholism is more socially acceptable and able to be explained away to themselves and those around them as fun and normal...

So perhaps they believe they are moderating, but just ignore the hiccups????

I am leaning towards the idea that moderation is just not possible, coz if you want some, you just going to want more!

EndGameNYC

You raise some very good concerns, awuh1. Many of your comments address the precise difficulties of doing research with any given sample. As Dee posted, this is a seventy-five-year study that's been ongoing since 1939 (JFK was one of the participants). Dr. Vaillant was born in 1934, and he and his staff continue to interview some of the original participants into their nineties. Participants would be invited back in for diagnostic and other interviews every eighteen months or so. The research study cited in this thread is actually part of a larger research program, The Study of Adult Development. The SAD captures such variables as success, interpersonal functioning and happiness over the lifespan.

The diagnostic criteria for and treatment of people who have problems with alcohol have changed significantly since the beginning of the study. It's always important to look at the sample recruited for the study, how they were selected, and how their characteristics change over time.

It's always been true that research protocols are tainted with bias. Someone wanting to demonstrate that something like moderation is a possibility for people who carry the diagnosis for alcohol use disorders is at risk for selecting a sample that suits his pre-study conclusions. Yet there are also checks and balances for such incidents and, in the main, they work very well.

There's currently a standardized diagnostic tool for research professionals that's based on the DSM known as the SCID, The Structured Clinical Interview for DSM-IV. It's about 250 pages of questions based on DSM psychiatric criteria. In all the research projects I've coordinated and for which I've consulted, I've probably administered a few thousand of them. There are other diagnostic instruments that are used to corroborate the SCID.

Even when Dr. Vaillant joined, and then led, the study, there existed no such consensus on criteria for alcohol dependence, and treatments consisted of being remanded to what were lovingly called "insane asylums" or the psychiatric unit in hospitals that had them.

When I have the time, I'll go back and look at the original research protocols in the Harvard Grant Study. I've no doubt I'll be fascinated by what I found, and I'm only surprised that I haven't looked sooner.

I can tell you from my own experience that studies in this area need to do a lot of good work before being granted money to initiate, proceed with and then continue their studies. I've been teaching other researchers to use the SCID for about twenty years, and I've done reliability studies on the DSM in the course of my career. I don't take diagnostics lightly, whether for research or clinical work, so I guess I fall on the conservative side. When I review research protocols, I need to be convinced that diagnostic criteria are strictly adhered to, and that such things as the process of sample selection are transparent.

Back to your original concern...Follow my lead and investigate how the researchers landed on their diagnostic criteria and how they selected their samples. At the very least, they should be using the SCID or some version of it. I'm wholly unimpressed when I read studies that demonstrate that alcoholics can happily moderate when the principal investigator chose people who are otherwise living happy and successful lives, and only wish that they didn't drink so much as their sample of alcoholics.

Your questions are complicated though easy to comprehend, but the answers are much more complex than what I can provide in a couple of posts. But it's usually important to ask.

silentrun

I thought about that as well. They have better ways of hiding it.

EndGameNYC

Sometimes we see politics where it doesn't exist. There's a vast array of variables studied in the overall research project of which the Harvard Grant Study is a part. The researchers also found that "liberal-minded people" had more satisfying romantic relationships and more and better sex. Doesn't sound like a bash to me.

caboblanco

there are studies that study quality of life and options in life as a deciding factor of recovery method and success from alcohol addiction ..I find those interesting....you never hear about those..people don't give them much credit

silentrun

yeah

jdooner

Cabo you are addressing what I think is an important topic. I am not threatened by moderation etc. In fact, i struggled with whether I am an alcoholic and an addict for quite some time. I am. Even after coming to terms with this, I would still question the ability to go back out and moderate - the basic definition of addiction.

I am working AA's 12 steps (step 4) and I still have thoughts but I now have tools to deal with these thoughts. But why would someone want to go back out and drink?

I mean, I have yet to meet anyone who has said alcohol did great things for me. I have met many that like feeling out of control, or th buzz or even the taste. But for those of us that fall into alcoholic or problem drinker I would doubt many have good things, yet most of us expend tons of energy to rationalize another drink or the ability to moderate a drink, why? Is it the psychology that we are missing out. Is it a broken reward motivation pathway system? The chemical changes in our brain or a combination of the above?