Short-term course of drinking in an untreated sample of at-risk drinkers

Objective: We know little about the short-term course of drinking, particul arly the stability or instability of at-risk drinking in untreated drinkers . Because few at-risk drinkers obtain help for their drinking, it is import ant to understand the short-term fluctuations between at-risk drinking and full-fledged alcohol use disorders, as well as remission of at-risk drinkin g. Method: We used four waves of data (each 6 months apart) from a probabil ity community sample of 733 at-risk drinkers in six states in the southern United States to determine variation in abstinence, drinking patterns and a lcohol use disorders over a 2-year period. For this analysis, we excluded t hose who reported receiving services for drinking during the 2-year study p eriod (retrospectively at baseline), leaving a sample size of 664 (444 male ); 479 (306 male) completed all four inter-views. Results: Although the maj ority (88%) of the sample was nonabstinent throughout the study, we found s ignificant decreases in average number of drinks per drinking day and recen t (past 6 months) alcohol disorders, and an increase in 6-month abstinence, Almost 30% of those with no recent alcohol disorder at baseline (n = 280) later met diagnostic criteria in at least one interview. Of those with a re cent alcohol disorder at baseline (n = 199), one third met criteria in at l east two subsequent interviews. Conclusions: There is some evidence for sho rt-term progression from at-risk drinking to alcohol disorder. However, the re is stronger evidence for declining problems and a fluctuation in and out of recovery and relapse, which may reflect an effort to maintain controlle d drinking, Understanding this short-term course is important for primary a nd secondary prevention efforts and for screening of at-risk drinking in pr imary care and in the workplace.