Remission of alcohol disorders in primary care patients - Does diagnosis matter?

BACKGROUND Alcohol use disorders (AUDs) are prevalent in primary care patie nt populations. Many primary care patients with AUDs can remit without form al treatment. An understanding of the factors that predispose patients to r emission may help primary care physicians provide effective brief counselin g for those with mild to moderate disorders and more effectively recommend formal treatment for others. METHODS A total of 119 eligible and randomly selected primary care patients with alcohol abuse or dependence in remission las defined in Diagnostic an d Statistical Manual of Mental Disorders third edition, revised participate d in a semistructured telephone interview. RESULTS Of the subjects, 59.7% were women, 50.4% had been alcohol dependent . 66.3% made a conscious decision to modify their drinking, and 62.1%. incl uding 54.2% of the alcohol-dependent subjects, moderated their drinking wit hout abstaining. Family, emotional, and medical issues most often prompted reduced drinking. Nearly one third of the subjects found specific strategie s and rules helpful in reducing their drinking, and many cited circumstance s that helped or hindered their efforts. Only 10.9% had formal alcohol trea tment. CONCLUSIONS A significant proportion of patients with AUDs remitted without formal treatment. Abstinence may not be necessary for a subset of dependen t patients. When counseling patients with active AUDs, primary care clinici ans are advised to counsel patients about the psychosocial and medical reas ons to control drinking, promote rule-setting about drinking, help patients avoid circumstances that trigger drinking, and support patients' attempts at moderating drinking rather than abstaining. Motivational interviewing (m otivational enhancement therapy) may provide a useful framework for such co unseling.