The first relapse into alcohol dependence after abstinence is characterized by sudden immoderate drinking. The time after abstinence to re-establishing dependence has never been compared to the time taken to establish dependence initially. Thirty one subjects who had been dependent on alcohol, had subsequently been abstinent for at least 2 months, and had had a relapse into dependence were interviewed. The median time to first dependence on alcohol was 13 years (Mean (SD) 14.7 (8) years); median time to dependence when relapsing was 7 days, a 700-fold acceleration (p < 0.00003). Only three subjects drank for more than 30 days (range 90-1825 days) before re-establishing dependence; the average was 82 (330) days overall and 9.3 (8.0) days if these subjects were excluded. Times to initial and subsequent dependence were not correlated nor related to the duration of abstinence (median 9, mean 16.9 (22) months). While abstinent the subjects had felt as if they were healed. It should be emphasized to abstinent patients that alcohol dependence has a latent sequel: they are at risk of accelerated dependence after recurrent drinking, which should be regarded as an emergency.

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