PREDICTORS OF RELAPSE IN LONG-TERM ABSTINENT ALCOHOLICS

Objective: The goals of this study were to examine the hazard of relap se during an average 11 years of follow-up in alcoholics who had achie ved long-term abstinence and to determine predictors of later relapse. Method: Male alcoholics (N = 77) with at least 18 months of stable ab stinence at time of entry were followed for 2 to 17 years (mean follow -up = 10.9 years). During follow-up, detailed information regarding re lapse/abstinence and interim drinking behavior was recorded. Potential predictors of relapse collected at enrollment included past drinking history, severity of alcohol-related life problems, degree of neurocog nitive impairment based on neuropsychological (NP) tests, psychologica l distress (MMPI) and past medical health. Results: Twenty-four of 77 (31%) long-term abstainers relapsed during the follow-up period. The a verage annual hazard rate of relapse was 3.8% in the first 5 years of follow-up and 2.6% over the next 6-11 years. Based on Cox proportional hazard regression analyses, the only significant variables to predict relapse were MMPI Scale 4 (Psychopathic Deviate, relative risk = 3.16 , 95% CI = 1.19-8.38) and prior history of alcohol-related life diffic ulty (i.e., citation for driving while intoxicated, relative risk = 2. 64, 95% CI = 1.05-6.64) (chi(2) = 14.2, 2 df, p < .001). Conclusions: There is approximately a 3% annual risk of relapse in alcoholics who h ave been able to achieve long-term abstinence, even after 5 years of a bstinence. Alcoholics who resumed drinking had greater indicators of l onger standing psychological trait disturbance, reflected in elevated MMPI Scale 4 and history of more alcohol-related social difficulties. Placing the present study in the context of previous research that foc used primarily on predictors or relapse in the shorter term, it appear s that, whereas mood disturbance predicts short-term outcome, more end uring personality traits predict long-term success in remaining abstin ent.