A 22‐Year Follow‐Up (Range 16 to 23) of Original Subjects with Baseline Alcohol Use Disorders from the Collaborative Study on Genetics of Alcoholism

Background:Little is known about remission, recovery, and other outcomes of alcohol use disorder (AUD) as defined by the DSM-5.Methods: Data from a large representative sample of the United States was used to examine correlates of past-year AUD status among individuals with prior-to-past-year AUD: persistent AUD, symptomatic high-risk drinking, asymptomatic high-risk drinking, symptomatic low-risk drinking, asymptomatic low-risk drinking (nonabstinent recovery, NAR), and abstainer (abstinent recovery, AR). Multiple logistic regression analyses were conducted to compare: (i) AR and NAR with persistent AUD, (ii) AR with NAR, and (iii) asymptomatic and symptomatic high-risk drinking with AR and NAR.Results: Among individuals with AUD prior to past year (n = 7,785), 34.2% were classified with persistent AUD, 8.8 and 1.6% were symptomatic high-risk and symptomatic low-risk drinkers, respectively, 21.5% were asymptomatic high-risk drinkers, 17.9% were asymptomatic low-risk drinkers, and 16.0% were abstainers. One-quarter of individuals with AUD prior to past year achieved AR or NAR without the benefit of treatment, while a much greater percentage of individuals achieving AR (43.2%) reported receiving treatment relative to those with NAR (12.3%). The number of lifetime AUD symptoms was greater among those achieving AR (among the treated) and lower among those achieving NAR relative to persistent AUD. The number of AUD symptoms was also greater among those achieving AR than NAR and lower among asymptomatic and symptomatic risk drinkers relative to those achieving AR and NAR. Consumption was greater among those achieving AR relative to those achieving NAR and greater among asymptomatic and symptomatic risk drinkers relative to AR and NAR. Odds of achieving AR or NAR relative to persistent AUD were generally lower among non-Hispanic Blacks and those with higher education, greater among women and married individuals, and lower among illicit drug users and individuals with histories of a personality disorder or mood/anxiety disorder.Conclusions: There appears to be a substantial level of recovery from AUD. Information on specific factors associated with AUD outcomes can be useful in targeting appropriate treatment efforts.

Section: Discussionsupporting

confidence: 88%

Prevalence and Correlates of Past‐Year Recovery From DSM‐5 Alcohol Use Disorder: Results From National Epidemiologic Survey on Alcohol and Related Conditions‐III

Fan

Chou

Zhang

et al. 2019

“…An unordered categorical measure was created to represent 3 groups: (i) those who did not meet criteria for DSM‐5 AUD during their lifetime; (ii) individuals who had a lifetime history of DSM‐5 AUD and were current problematic drinkers due to an active AUD diagnosis in the past 12 months or were high‐risk drinkers (defined as men: ≥5 drinks/d or ≥15 drinks in 1 week; women: ≥4 drinks/d or ≥8 in 1 week; National Institute on Alcohol Abuse and Alcoholism, ); and (iii) those who had a lifetime history of AUD but had reduced/ceased their drinking and either did not report any AUD criteria (except craving), or were not high‐risk drinkers, or were abstinent from alcohol, all in the past 12 months (McCutcheon et al., ; Schuckit et al., ). A comparison of Group A against either Group B or Group C contrasts presence or absence of a lifetime diagnosis of DSM‐5 AUD, while the comparison of Group B and Group C stratifies those with a lifetime diagnosis into high‐risk drinkers, including those with active AUD, and low‐risk drinkers who may also be in abstinent remission.…”

Section: Methodsmentioning

confidence: 99%

The Genetic Relationship Between Alcohol Consumption and Aspects of Problem Drinking in an Ascertained Sample

Johnson

Pierre

Meyers

et al. 2019

Self Cite

Background: Genomewide association studies (GWAS) have begun to identify loci related to alcohol consumption, but little is known about whether this genetic propensity overlaps with specific indices of problem drinking in ascertained samples.Methods: In 6,731 European Americans who had been exposed to alcohol, we examined whether polygenic risk scores (PRS) from a GWAS of weekly alcohol consumption in the UK Biobank predicted variance in 6 alcohol-related phenotypes: alcohol use, maximum drinks within 24 hours (MAXD), total score on the Self-Rating of the Effects of Ethanol Questionnaire (SRE-T), DSM-IV alcohol dependence (DSM4AD), DSM-5 alcohol use disorder symptom counts (DSM5AUDSX), and reduction/cessation of problematic drinking. We also examined the extent to which an single nucleotide polymorphism (rs1229984) in ADH1B, which is strongly associated with both alcohol consumption and dependence, contributed to the polygenic association with these phenotypes and whether PRS interacted with sex, age, or family history of alcoholism to predict alcohol-related outcomes. We performed mixed-effect regression analyses, with family membership and recruitment site included as random effects, as well as survival modeling of age of onset of DSM4AD.Results: PRS for alcohol consumption significantly predicted variance in 5 of the 6 outcomes: alcohol use (Dmarginal R 2 = 1.39%, D area under the curve [AUC] = 0.011), DSM4AD (Dmarginal R 2 = 0.56%; DAUC = 0.003), DSM5AUDSX (Dmarginal R 2 = 0.49%), MAXD (Dmarginal R 2 = 0.31%), and SRE-T (Dmarginal R 2 = 0.22%). PRS were also associated with onset of DSM4AD (hazard ratio = 1.11, p = 2.08eÀ5). The inclusion of rs1229984 attenuated the effects of the alcohol consumption PRS, particularly for DSM4AD and DSM5AUDSX, but the PRS continued to exert an independent effect for all 5 alcohol measures (Dmarginal R 2 after controlling for ADH1B = 0.14 to 1.22%). Interactions between PRS and sex, age, or family history were nonsignificant.Conclusions: Genetic propensity for typical alcohol consumption was associated with alcohol use and was also associated with 4 of the additional 5 outcomes, though the variance explained in this sample was modest. Future GWAS that focus on the multifaceted nature of AUD, which goes beyond consumption, might reveal additional information regarding the polygenic underpinnings of problem drinking.

“…In sum, relative to the general population, a smaller percentage of interviewed older COGA subjects were currently drinking, but those who did exhibited far greater levels of high‐risk consumption. Schuckit and colleagues () provide additional details about the characteristics and predictors of these older COGA pilot subjects’ alcohol involvement, classifying them into subgroups arrayed along a continuum of severity.…”

Section: Discussionmentioning

confidence: 99%

“…A number of long‐term follow‐up investigations have examined the precursors of older age alcohol involvement (see Schuckit et al., , for a detailed review). In these studies, samples range considerably both in size and in type, including registry‐based population samples (Kendler et al., ), former students (Gonçalves et al., ; Vaillant, ), community residents (Moos et al., ; Vaillant, ), civil servants (Knott et al., ), and clinic outpatients (Holahan et al., ).…”

mentioning

confidence: 99%

A Pilot Follow‐Up Study of Older Alcohol‐Dependent COGA Adults

Chan

Kramer

Schuckit

et al. 2019

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Background: Alcohol consumption and problems are increasing among older adults, who are at elevated risk for alcohol-related accidents and medical problems. This paper describes a pilot follow-up of older adults with a history of alcohol dependence that was designed to determine the feasibility of conducting a more extensive investigation.Methods: The sample consisted of previously assessed subjects in the Collaborative Studies on the Genetics of Alcoholism who: (i) were age 50+; (ii) had lifetime DSM-IV AD; and (iii) had DNA available. Individuals were located through family contacts, Internet searches, and death registries. A brief telephone interview assessed demographics, health, and alcohol involvement.Results: Of the total sample (N = 2,174), 36% were contacted, 24% were deceased, and 40% were not yet located. Most (89%) contacted subjects were interviewed, and 99% of them agreed to future evaluation. Thirty percent of interviewed subjects reported abstinence for 10+ years, 56% reported drinking within the past year, and 14% last drank between >1 and 10 years ago. There were no age-related past-year differences in weekly consumption (overall sample mean: 16 drinks), number of drinking weeks (30.8), maximum number of drinks in 24 hours (8.1), or prevalence of weekly risky drinking (19%). Among those who drank within the past 5 years, the 3 most common alcohol-related problems were spending excessive time drinking or recovering (49%), drinking more/longer than intended (35%), and driving while intoxicated (35%); and about a third (32%) received some form of treatment.Conclusions: Over a 1-year period, we located 60% of individuals last seen an average of 23 years ago. The majority of contacted individuals were interviewed and willing to be evaluated again. Although the proportion of individuals currently drinking diminished with age, subjects exhibited troublesome levels of alcohol consumption and problems. Our findings suggest the importance and feasibility of a more comprehensive follow-up.