Time to alcohol dependence after abstinence and first drink

Abstract

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.

Gender differences in the relations between depressive symptoms and drinking behavior among problem drinkers: A three-wave study.

“…This pattern is consistent with prior work (a) indicating that depressive symptoms can contribute to the chronicity of women's problem drinking (Wilsnack, Klassen, Schur, & Wilsnack, 1991) and (b) linking depressive symptoms with relapse or more rapid relapse of drinking problems (Glenn & Parsons, 1991; Svanum & McAdoo, 1989). Given that the time from relapse to alcohol dependence may be short (Besançon, 1993), our results suggest that clinicians should attend to problem drinkers’ depressive symptoms, even in absence of a diagnosed disorder.…”

Relapse as a nonlinear dynamic system: Application to patients with alcohol use disorders.

“…Patients who relapse often transition from sobriety back to heavy drinking in a relatively short amount of time in the first few months after treatment (Project MATCH Research Group, 1997). While the exact temporal parameters underlying the relapse process clearly need more research, it is widely recognized that the process whereby an alcoholic returns to drinking after a period of sobriety takes less time than the development of the alcohol dependence in the first place (Besancon, 1993). More importantly, the transition between sobriety and relapse to substance use is unlikely to be gradual among those with a history of a substance use disorder (Dimeff & Marlatt, 1998).…”

Novel approaches for the treatment of psychostimulant and opioid abuse – focus on opioid receptor-based therapies

“…This issue has led to the development of adapted self-administration paradigms in an attempt to better model these behaviours [16–18]. A further aspect of human relapse that is currently poorly modelled and poorly understood is the rapid transition from abstinence to compulsive drug use at the start of a relapse episode [19]. These differences between current animal models of addiction and human addiction may be related to chronic drug users having defective frontal cortex function, compared with ‘standard’ laboratory rodents [20].…”