ABSTRACT
Aims: 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.
Design: Prospective cohort study with assessments at baseline and two-year follow-up.
Setting: Recruitment from the general population, primary care and outpatient mental health care services.
Participants: Persons with remitted AD (n=253) and current AD (n=135).
Measurements: 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.
Findings: 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.
Conclusions: 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.