Social Contexts of Remission from DSM-5 Alcohol Use Disorder in a High-Risk Sample

Abstract

Background Measures of social context, such as marriage and religious participation, are associated with remission from alcohol use disorders (AUD) in population-based and treatment samples, but whether these associations hold among individuals at high familial risk for AUD is unknown. This study tests associations of measures of social context and treatment with different types of remission from DSM-5 AUD in a high-risk sample. Methods Subjects were 686 relatives of probands (85.7% first-degree) who participated in a high-risk family study of alcohol dependence. All subjects met criteria for AUD at baseline and were re-interviewed 5 years later. Follow-up status was categorized as persistent AUD, high-risk drinking, remitted low-risk drinking, and abstinence. Social context measures were defined as stable or changing from baseline to follow-up, and their bivariate and multivariate associations with follow-up status were tested. Results At follow-up, 62.8% of subjects had persistent AUD, 6.4% were high-risk drinkers, 22.2% were remitted low-risk drinkers, and 8.6% were abstinent. Birth of first child during the interval was the only measure of social context associated with remitted low-risk drinking and was significant for women only. Abstinent remission was characterized by being stably separated or divorced for women, new marriage for both sexes, experiencing low levels of family support and high levels of friend support, and receiving treatment. High-risk drinkers were more likely than individuals with persistent AUD to have a stable number of children and to have been recently unemployed. Conclusions The social contexts accompanying different types of remission in this high-risk sample resemble those found in population-based and clinical samples. Low-risk drinkers resemble natural remitters from population-based samples who change their drinking habits with life transitions. Abstainers resemble clinical samples in marital context, support from friends, and treatment. High-risk drinkers appear to continue to experience negative consequences of heavy drinking.

Familial association of abstinent remission from alcohol use disorder in first‐degree relatives of alcohol‐dependent treatment‐seeking probands

“…In the current study we used data from a high-risk family study, the Collaborative Study on the Genetics of Alcoholism (COGA), which has a high prevalence of lifetime AUD in the relatives of probands (19) and thus provides enough AUD-affected, and thus potentially remitted, proband-relative pairs to model persistent AUD, non-abstinent remission, and abstinent remission in both subjects. Greater AUD severity was associated with decreased likelihood of non-abstinent remission and increased likelihood of abstinent remission in population-based data and in previous work in COGA (10, 30, 37), consistent with other studies that found abstinent individuals had more severe AUD histories than non-abstinent individuals (27, 38, 39). Because AUD severity might influence familial associations of remission in a way similar to its association with familial transmission of AUD (40), we categorized remission as abstinent and non-abstinent.…”

“…In contrast, some of the most consistent correlates of both abstinent and non-abstinent remission are social connections such as marriage, friendship and religious or self-help group attendance [27][28][29][30]. Traits that might enhance these connections, such as social cognition [31][32][33], might also be associated with the ability to remit.…”

Remission from Alcohol Use Disorder among Males in the Lundby Cohort during 1947–1997

“…Earlier research from the Lundby Study found that social stabilisation, unspecific treatment, family, peer pressure, and medical complications were important attributions for remission [10]. Further the role of social connection in remission from AUD has been documented in a wide variety of samples [35]. In the present study findings suggested that contact with health care could be a positive factor for achieving remission.…”

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

“…In univariate analyses in Table , Problem Drinkers also had higher baseline maximum quantities, drinking frequencies, alcohol problems, illicit drug use, and drug problems. The greater difference between these 2 groups in COGA versus more white‐collar individuals in the Gonçalves and colleagues () study could reflect moderation of the course of Problem Drinking by higher levels of education and socioeconomic factors in the earlier study (Bucholz et al., ; McCutcheon et al., ). Even though the outcome and baseline problems were not as severe for High‐Risk Drinking participants, it is important to remember high alcohol consumption still carries a greater risk for alcohol‐related health problems (Breslow et al., ; Grant et al., ; Moore et al., ; Praud et al., ; Shield et al., ).…”