First-Year Treatment Success Lowers 15-Year Death Risk for Alcoholics
Adults who are in remission one year after seeking professional help for alcoholism are less likely to die over the next 15 years than those who are in relapse, a new study has found.
The likelihood of dying is also reduced for alcoholics who undergo a longer duration of outpatient treatment or Alcoholics Anonymous participation during the first year, provided they are doing well at the one-year mark.
"The initial year is critical," said lead author Christine Timko, Ph.D., a research scientist at the Veterans Health Administration in Palo Alto, Calif. "Getting help early and getting enough help early is a key factor in recovery from alcohol problems and in reducing mortality."
On average, participants were in their mid-thirties when they started the study, which appears in the October issue of Alcoholism: Clinical and Experimental Research.
Alcohol abuse and dependence increase the risk of premature death. Previous studies have shown that adults treated for alcohol use disorders have a death rate that is 1.6 to 4.7 times greater than the mortality rate for the general American population.
In this study, researchers followed 628 adults in the San Francisco Bay area who had not received prior treatment for an alcohol use disorder. All of the participants were seeking treatment voluntarily and about half were women.
Over the 16-year follow-up period, 19.3 percent of participants died. The mortality rate in this population was 1.4 times greater than expected for the general population, but it was lower than the rate reported in other treatment studies.
"Most studies include a combination of long-term chronic users and first-timers," said Timko. "We think the mortality ratio was lower than expected because these were people who had not had help before and were catching their alcohol problems early."
Not surprisingly, those who initially had more severe alcohol-related problems were at greater risk of dying. Men were more likely to die than women, and single adults were more likely to die than married adults.
When the researchers controlled for these characteristics, they found that the participants who had no drinking-related problems or were in remission at one year were significantly less likely to die over the next 15 years than those who had problems caused by their alcohol use or who were still abusing alcohol.
Certain combinations of one-year outcome and treatment were also predictive of a lower risk of death. Participants who received more than eight weeks of outpatient treatment or who attended Alcoholics Anonymous meetings for more than 16 weeks and who had no drinking-related problems at one year were less likely to die than other groups.
"What kind of help people get doesn't matter nearly as much as that they get some kind of help," said Timko. "While 12-step groups provide social support and support for recovery, we need to have a whole range of treatment options out there for people so that they can self-select into the one that they want."
While a longer duration of outpatient treatment was associated with a reduced risk of death, the reverse was true for inpatient treatment. Those who spent less than three weeks in inpatient treatment and were doing well at one year were less likely to die over the 16-year study period than those with a longer duration of inpatient treatment, even if they were doing well at one year.
"Long-term inpatient treatment is a red flag," said University of Massachusetts professor of medicine Judith Ockene, Ph.D. "We need to think about how to keep patients out of long-term care, which gets back to the tremendously important role of the physician and the health care system. If we want to prevent the downstream effects of alcohol abuse we really need to start intervening much more upstream."