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Wednesday, February 29, 2012

Predictors of the two-year recurrence and persistence of alcohol dependence

To identify independent risk factors of the recurrence of alcohol dependence (AD) in persons with a remitted disorder at baseline and persistence of AD in persons with a current disorder at baseline.

Prospective cohort study with assessments at baseline and two-year follow-up.

Recruitment from the general population, primary care and outpatient mental health care services.

Persons with remitted AD (n=253) and current AD (n=135).

Recurrence and persistence of AD during two-year follow-up were established with the CIDI interview based on DSM-IV. Logistic regression analyses were performed to explore the role of potential risk factors (i.e., baseline severity of alcohol problems, measures for depression and anxiety, sociodemographics, vulnerability factors, and addiction-related factors) as independent predictors of a negative course.

Overall recurrence and persistence rates of AD were 14.6% and 40.7%, respectively, and were highly conditional on the severity of alcohol problems (adjusted OR per SD increase: OR=3.64, 95%CI=2.21-6.01 and OR=2.12, 95%CI=1.32-3.40, respectively). Severity of depressive/anxiety symptoms was an additional independent predictor of the recurrence of AD, whereas male gender and high education were significant, independent risk factors of the persistence of AD.

Alcohol dependence has a dynamic course with only moderate levels of diagnostic stability. Both recurrence and persistence of alcohol dependence are highly dependent on severity of baseline alcohol problems, whereas severity of depressive/anxiety symptoms only predicts the recurrence of alcohol dependence. Both measures may be useful in identifying persons at an increased risk of a negative course and who could be targeted by prevention strategies.

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