Research that goes beyond an initial resolution of harmful and hazardous drinking to how these changes are maintained over the long-term can enhance health-related recommendations and guidelines. In this study, researchers investigated factors associated with achieving both early and sustained cessation of heavy drinking in a large primary care sample.
l
Unhealthy alcohol use can range from risky drinking to alcohol use disorder including alcohol addiction. Such drinking can have a negative impact on health, including disruptions to brain, heart, liver, pancreas, and the immune functioning as well as cause social and familial consequences. In the United States, alcohol use is a leading cause of death and is estimated to cost the United States over $249 billion annually. Although many studies target individuals with alcohol use disorder in treatment and recovery support service settings, much of the disease burden from alcohol is caused by excessive drinking, rather than alcohol use disorder, per se, as this represents a much large number of people. Little is known, however, on how heavy drinkers change, such as reduce or abstain from drinking, in the 1st year after they screen positive for heavy drinking. Furthermore, evidence is lacking that explores what factors predict sustained cessation of heavy drinking or abstinence over time. This study sought to identify what characteristics (e.g., race/ethnicity) and experiences (e.g., addiction treatment) are associated with achieving cessation of heavy drinking over 5 years using a large sample of adults engaged in primary care.
In this retrospective study, researchers analyzed electronic health records of adults in the Kaiser Permanente Northern California (KPNC) health care network that screened positive for heavy drinking during a routine primary care visit that took place between June 1st, 2013, and May 31st, 2014. The KPNC network serves 4.3 million adults (~1/3 of the Northern Californian population) and has systematically screened for heavy drinking in adult primary care with approximately 80% of its members successfully screened. The main outcome of this study was the cessation of heavy drinking. Screening for heavy drinking consisted of a medical staff member asking three questions: (1) ‘How many times in the past 3 months have you had five/four or more drinks containing alcohol in a day?’ for men aged 18-65 and men aged ≥ 66 or women respectively; (2) ‘On average, how many days per week do you have an alcoholic drink?’, and (3) ‘On a typical drinking day, how many drinks do you have?’. Heavy drinking was positive if a person exceeded either daily (5+ drinks for men aged 18-66 or 4+ for men aged ≥66 and women) or weekly limits (14 drinks/week for men aged 18-66 or 7 drinks/week for men aged ≥66 and women), based on the National Institute of Alcohol Abuse and Alcoholism (NIAAA) guidelines at the time of the initial screening. Early cessation of heavy alcohol use was defined as reporting lower-risk drinking (no heavy drinking days or weeks in the past 3 months) or abstinence at all screenings up to 1-year after the first positive heavy drinking screening. Sustained cessation of heavy alcohol use was defined as obtaining early cessation and reporting lower drinking or abstinence at all screenings up to the 5-year follow-up screening. Possible predictors were also collected and included socio-demographic characteristics, smoking status, drinking level (e.g., exceeding daily, weekly, or both daily and weekly heavy drinking limits), psychiatric disorders, alcohol and other substance use disorders, psychiatric or addiction treatment, routine (i.e., annual) primary care visits, and the type of early cessation (low-risk drinking or abstinence).
All enrollees that screened positive for heavy drinking during the index period (June 1st, 2013, and May 31st, 2014) were eligible to be included. During the 1-year eligibility period, 200,458 adults screened positive for heavy drinking. For each adult, all alcohol screens for the following 63 months were collected. The screenings closest to 1-year and 5-year post index screening were used for early and sustained cessation markers respectively. Approximately 46% of these patients were lost to follow-up due to death, disenrollment from Kaiser Permanente, or not having a 1 year screening, which resulted in 85,434 adults with observed alcohol use data that were used in the final analyses. Among those adults, 53,916 achieved early cessation and were eligible for the sustained cessation analysis, resulting in 19,200 adults with complete outcome data 5 years after index screening. The study accounted statistically for differences in attrition (i.e., likelihood of dropping out of the care during the study window).
Of the 85,434 adults in the analytical sample: 34,761 (40.7%) were females and 28,853 (33.8%) identified as non-white. The average age was 50.3 and 11,914 (13.9%) reported current smoking. Most – 50,193 (58.8%) – exceeded only daily drinking limits, while 20,835 (24.4%) exceeded only weekly limits and 14,406 (16.9%) exceeded both daily and weekly limits. There were also 4,057 (4.7%) adults who met criteria for an alcohol use disorder.
Most that screened positive for heavy alcohol use achieved early cessation.
A total of 53,916 (63.1%) adults that screened positive for heavy drinking achieved early cessation. Among those that achieved early cessation, 25,289 (46.9%) reported abstinence and 28,627 (53.1%) reported lower-risk drinking. Similarly, close to 2/3 (60.0%, 11,539) of the 19,200 that achieved early cessation and had outcome data reported sustained heavy drinking cessation.
Early cessation was more likely among females compared to males and those that did not identify as White.
The researchers found that several demographic characteristics and experiences were linked with higher odds of achieving early cessation. However, those identifying as female compared to male and/or Asian, Native Hawaiian, or Pacific Islander, Black, Latinx/Hispanic, or Native American compared to white were the strongest predictors.
Engagement in services (primary care and addiction treatment) was associated with sustained (5-year) cessation.
Among the 19,200 adults that achieved early (1-year) heavy drinking cessation, those that participated in routine (i.e., annual) primary care had a 57% increase in odds of achieving sustained (5-year) cessation compared to those that did not have routine primary care.
Surprisingly, individuals that attended psychiatric treatment within the first year after being identified with heavy drinking had lower odds of early cessation compared to those that did not. Moreover, adults that attended psychiatric treatment within the first year after positive heavy drinking screening did not differ in odds of achieving sustained cessation compared to those that did not attend psychiatric treatment. Attending addiction treatment, however, was associated with a 19% and 41% increase in odds of achieving early and sustained cessation respectively. Addiction treatment was one of the stronger predictors of sustained heavy drinking cessation.
Abstinence but not Alcohol use disorder diagnosis linked to early or sustained cessation.
Among all adults that screened positive for heavy drinking, 4.7% (4,057) were also diagnosed with an alcohol use disorder. Those with an alcohol use disorder diagnosis were no more likely or less likely to achieve early or sustained cessation of heavy drinking.
Adults that reported abstinence at 1-year were more likely to achieve sustained cessation compared to those reporting low-risk drinking. This effect was even larger among those with alcohol use disorder. For those with alcohol use disorder, abstinence was associated with 2.27 greater odds of sustaining cessation. For those without alcohol use disorder the odds ratio was the same as for the overall sample.
Nationwide, there are tens of millions of individuals that have resolved a substance use problem, and over half of those identify alcohol as the primary problem substance. However, most individuals do not seek or receive help for mild to moderate problematic drinking, highlighting the need to understand how individuals might resolve heavy drinking including. The need includes both those who do and do not attend treatment, and more importantly as it has been studied less often, how these individuals sustain this change over time. The researchers in this study explored what characteristics and behavioral health service utilization predict early (1-year) and sustained (5-year) cessation of heavy drinking. They found that 2/3 of adults that were identified through screening achieved early cessation of heavy drinking. This is higher than previous studies and suggests that screening during primary care may help identify alcohol problems before severity increases and link to needed treatments. Furthermore, the researchers found that routine primary care visits, independent of other factors, was the strongest predictor of sustained cessation. The impact of primary care may be especially useful for those without high severity drinking issues or alcohol use disorder. Primary care may be uniquely situated to address overall medical needs impacting drinking behaviors, identify and treat heavy drinking relapse, promote healthy lifestyles, and link to targeted services. It is also possible that attending routine primary care reflects a larger commitment to healthy lifestyle and some factors that were not measured are responsible for individuals’ drinking change and ability to sustain that change over time.
The type of early drinking cessation mattered for sustaining cessation. Those who reported abstinence at 1-year were more likely to achieve sustained cessation compared to those who reported lower-risk drinking. Previous research has shown that some individuals are able to drink and function as well as those that are abstinent in some domains such as psychological functioning, employment, life satisfaction, and mental health, the greater health risks of their heavier drinking notwithstanding. So, for some, lower risk drinking or lifestyle changes may be most appropriate. In this study, however, it was found that adults who reported abstinence at 1-year were more likely to report sustained cessation of heavy drinking after 5 years compared adults engaging in low-risk drinking. The long-term benefits of abstinence found in this study mirrors findings from the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), a nationally representative sample of U.S. adults. Researchers analyzing the NESCARC data found that abstinence represented the most stable form of remission from alcohol dependence compared to high- and low-risk drinkers after 3 years. Furthermore, researchers exploring a Dutch sample of adults also found that any alcohol use among those in alcohol use disorder remission was a significant risk factor for relapse to active alcohol use disorder. One contribution of the work done here is the inclusion of adults identified with heavy drinking behavior yet do not meet alcohol use disorder criteria; while showing that half of heavy drinkers stop drinking heavily through a low-risk drinking pathway, this study also highlights the greater stability of an abstinence approach to risk reduction and cessation of heavy drinking over time. This finding aligns with previous work highlighting the increased benefits of abstinence.
Two-thirds of adults that were able to be followed up in this study that screened positive initially for heavy drinking in this retrospective cohort study of primary care patients achieved early (1-year) cessation of heavy drinking and of those that achieve early cessation, nearly 2/3 reported sustained (5-year) heavy drinking cessation. Routine primary care was the strongest predictor of sustained cessation. Addiction treatment was also one of the stronger predictors of both early and sustained cessation. Abstinence was linked to higher odds of sustained (5-year) heavy drinking cessation, and this effect was even bigger among those with alcohol use disorder. This study explored the types of factors that predict cessation of heavy drinking as well as what factors predict its stability over time in a primary care sample of adults.
Palzes, V. A., Kline‐Simon, A. H., Satre, D. D., Sterling, S., Weisner, C., & Chi, F. W. (2022). Predictors of early and sustained cessation of heavy drinking over 5 years among adult primary care patients. Addiction, 117(1), 82–95. doi: 10.1111/add.15612
l
Unhealthy alcohol use can range from risky drinking to alcohol use disorder including alcohol addiction. Such drinking can have a negative impact on health, including disruptions to brain, heart, liver, pancreas, and the immune functioning as well as cause social and familial consequences. In the United States, alcohol use is a leading cause of death and is estimated to cost the United States over $249 billion annually. Although many studies target individuals with alcohol use disorder in treatment and recovery support service settings, much of the disease burden from alcohol is caused by excessive drinking, rather than alcohol use disorder, per se, as this represents a much large number of people. Little is known, however, on how heavy drinkers change, such as reduce or abstain from drinking, in the 1st year after they screen positive for heavy drinking. Furthermore, evidence is lacking that explores what factors predict sustained cessation of heavy drinking or abstinence over time. This study sought to identify what characteristics (e.g., race/ethnicity) and experiences (e.g., addiction treatment) are associated with achieving cessation of heavy drinking over 5 years using a large sample of adults engaged in primary care.
In this retrospective study, researchers analyzed electronic health records of adults in the Kaiser Permanente Northern California (KPNC) health care network that screened positive for heavy drinking during a routine primary care visit that took place between June 1st, 2013, and May 31st, 2014. The KPNC network serves 4.3 million adults (~1/3 of the Northern Californian population) and has systematically screened for heavy drinking in adult primary care with approximately 80% of its members successfully screened. The main outcome of this study was the cessation of heavy drinking. Screening for heavy drinking consisted of a medical staff member asking three questions: (1) ‘How many times in the past 3 months have you had five/four or more drinks containing alcohol in a day?’ for men aged 18-65 and men aged ≥ 66 or women respectively; (2) ‘On average, how many days per week do you have an alcoholic drink?’, and (3) ‘On a typical drinking day, how many drinks do you have?’. Heavy drinking was positive if a person exceeded either daily (5+ drinks for men aged 18-66 or 4+ for men aged ≥66 and women) or weekly limits (14 drinks/week for men aged 18-66 or 7 drinks/week for men aged ≥66 and women), based on the National Institute of Alcohol Abuse and Alcoholism (NIAAA) guidelines at the time of the initial screening. Early cessation of heavy alcohol use was defined as reporting lower-risk drinking (no heavy drinking days or weeks in the past 3 months) or abstinence at all screenings up to 1-year after the first positive heavy drinking screening. Sustained cessation of heavy alcohol use was defined as obtaining early cessation and reporting lower drinking or abstinence at all screenings up to the 5-year follow-up screening. Possible predictors were also collected and included socio-demographic characteristics, smoking status, drinking level (e.g., exceeding daily, weekly, or both daily and weekly heavy drinking limits), psychiatric disorders, alcohol and other substance use disorders, psychiatric or addiction treatment, routine (i.e., annual) primary care visits, and the type of early cessation (low-risk drinking or abstinence).
All enrollees that screened positive for heavy drinking during the index period (June 1st, 2013, and May 31st, 2014) were eligible to be included. During the 1-year eligibility period, 200,458 adults screened positive for heavy drinking. For each adult, all alcohol screens for the following 63 months were collected. The screenings closest to 1-year and 5-year post index screening were used for early and sustained cessation markers respectively. Approximately 46% of these patients were lost to follow-up due to death, disenrollment from Kaiser Permanente, or not having a 1 year screening, which resulted in 85,434 adults with observed alcohol use data that were used in the final analyses. Among those adults, 53,916 achieved early cessation and were eligible for the sustained cessation analysis, resulting in 19,200 adults with complete outcome data 5 years after index screening. The study accounted statistically for differences in attrition (i.e., likelihood of dropping out of the care during the study window).
Of the 85,434 adults in the analytical sample: 34,761 (40.7%) were females and 28,853 (33.8%) identified as non-white. The average age was 50.3 and 11,914 (13.9%) reported current smoking. Most – 50,193 (58.8%) – exceeded only daily drinking limits, while 20,835 (24.4%) exceeded only weekly limits and 14,406 (16.9%) exceeded both daily and weekly limits. There were also 4,057 (4.7%) adults who met criteria for an alcohol use disorder.
Most that screened positive for heavy alcohol use achieved early cessation.
A total of 53,916 (63.1%) adults that screened positive for heavy drinking achieved early cessation. Among those that achieved early cessation, 25,289 (46.9%) reported abstinence and 28,627 (53.1%) reported lower-risk drinking. Similarly, close to 2/3 (60.0%, 11,539) of the 19,200 that achieved early cessation and had outcome data reported sustained heavy drinking cessation.
Early cessation was more likely among females compared to males and those that did not identify as White.
The researchers found that several demographic characteristics and experiences were linked with higher odds of achieving early cessation. However, those identifying as female compared to male and/or Asian, Native Hawaiian, or Pacific Islander, Black, Latinx/Hispanic, or Native American compared to white were the strongest predictors.
Engagement in services (primary care and addiction treatment) was associated with sustained (5-year) cessation.
Among the 19,200 adults that achieved early (1-year) heavy drinking cessation, those that participated in routine (i.e., annual) primary care had a 57% increase in odds of achieving sustained (5-year) cessation compared to those that did not have routine primary care.
Surprisingly, individuals that attended psychiatric treatment within the first year after being identified with heavy drinking had lower odds of early cessation compared to those that did not. Moreover, adults that attended psychiatric treatment within the first year after positive heavy drinking screening did not differ in odds of achieving sustained cessation compared to those that did not attend psychiatric treatment. Attending addiction treatment, however, was associated with a 19% and 41% increase in odds of achieving early and sustained cessation respectively. Addiction treatment was one of the stronger predictors of sustained heavy drinking cessation.
Abstinence but not Alcohol use disorder diagnosis linked to early or sustained cessation.
Among all adults that screened positive for heavy drinking, 4.7% (4,057) were also diagnosed with an alcohol use disorder. Those with an alcohol use disorder diagnosis were no more likely or less likely to achieve early or sustained cessation of heavy drinking.
Adults that reported abstinence at 1-year were more likely to achieve sustained cessation compared to those reporting low-risk drinking. This effect was even larger among those with alcohol use disorder. For those with alcohol use disorder, abstinence was associated with 2.27 greater odds of sustaining cessation. For those without alcohol use disorder the odds ratio was the same as for the overall sample.
Nationwide, there are tens of millions of individuals that have resolved a substance use problem, and over half of those identify alcohol as the primary problem substance. However, most individuals do not seek or receive help for mild to moderate problematic drinking, highlighting the need to understand how individuals might resolve heavy drinking including. The need includes both those who do and do not attend treatment, and more importantly as it has been studied less often, how these individuals sustain this change over time. The researchers in this study explored what characteristics and behavioral health service utilization predict early (1-year) and sustained (5-year) cessation of heavy drinking. They found that 2/3 of adults that were identified through screening achieved early cessation of heavy drinking. This is higher than previous studies and suggests that screening during primary care may help identify alcohol problems before severity increases and link to needed treatments. Furthermore, the researchers found that routine primary care visits, independent of other factors, was the strongest predictor of sustained cessation. The impact of primary care may be especially useful for those without high severity drinking issues or alcohol use disorder. Primary care may be uniquely situated to address overall medical needs impacting drinking behaviors, identify and treat heavy drinking relapse, promote healthy lifestyles, and link to targeted services. It is also possible that attending routine primary care reflects a larger commitment to healthy lifestyle and some factors that were not measured are responsible for individuals’ drinking change and ability to sustain that change over time.
The type of early drinking cessation mattered for sustaining cessation. Those who reported abstinence at 1-year were more likely to achieve sustained cessation compared to those who reported lower-risk drinking. Previous research has shown that some individuals are able to drink and function as well as those that are abstinent in some domains such as psychological functioning, employment, life satisfaction, and mental health, the greater health risks of their heavier drinking notwithstanding. So, for some, lower risk drinking or lifestyle changes may be most appropriate. In this study, however, it was found that adults who reported abstinence at 1-year were more likely to report sustained cessation of heavy drinking after 5 years compared adults engaging in low-risk drinking. The long-term benefits of abstinence found in this study mirrors findings from the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), a nationally representative sample of U.S. adults. Researchers analyzing the NESCARC data found that abstinence represented the most stable form of remission from alcohol dependence compared to high- and low-risk drinkers after 3 years. Furthermore, researchers exploring a Dutch sample of adults also found that any alcohol use among those in alcohol use disorder remission was a significant risk factor for relapse to active alcohol use disorder. One contribution of the work done here is the inclusion of adults identified with heavy drinking behavior yet do not meet alcohol use disorder criteria; while showing that half of heavy drinkers stop drinking heavily through a low-risk drinking pathway, this study also highlights the greater stability of an abstinence approach to risk reduction and cessation of heavy drinking over time. This finding aligns with previous work highlighting the increased benefits of abstinence.
Two-thirds of adults that were able to be followed up in this study that screened positive initially for heavy drinking in this retrospective cohort study of primary care patients achieved early (1-year) cessation of heavy drinking and of those that achieve early cessation, nearly 2/3 reported sustained (5-year) heavy drinking cessation. Routine primary care was the strongest predictor of sustained cessation. Addiction treatment was also one of the stronger predictors of both early and sustained cessation. Abstinence was linked to higher odds of sustained (5-year) heavy drinking cessation, and this effect was even bigger among those with alcohol use disorder. This study explored the types of factors that predict cessation of heavy drinking as well as what factors predict its stability over time in a primary care sample of adults.
Palzes, V. A., Kline‐Simon, A. H., Satre, D. D., Sterling, S., Weisner, C., & Chi, F. W. (2022). Predictors of early and sustained cessation of heavy drinking over 5 years among adult primary care patients. Addiction, 117(1), 82–95. doi: 10.1111/add.15612
l
Unhealthy alcohol use can range from risky drinking to alcohol use disorder including alcohol addiction. Such drinking can have a negative impact on health, including disruptions to brain, heart, liver, pancreas, and the immune functioning as well as cause social and familial consequences. In the United States, alcohol use is a leading cause of death and is estimated to cost the United States over $249 billion annually. Although many studies target individuals with alcohol use disorder in treatment and recovery support service settings, much of the disease burden from alcohol is caused by excessive drinking, rather than alcohol use disorder, per se, as this represents a much large number of people. Little is known, however, on how heavy drinkers change, such as reduce or abstain from drinking, in the 1st year after they screen positive for heavy drinking. Furthermore, evidence is lacking that explores what factors predict sustained cessation of heavy drinking or abstinence over time. This study sought to identify what characteristics (e.g., race/ethnicity) and experiences (e.g., addiction treatment) are associated with achieving cessation of heavy drinking over 5 years using a large sample of adults engaged in primary care.
In this retrospective study, researchers analyzed electronic health records of adults in the Kaiser Permanente Northern California (KPNC) health care network that screened positive for heavy drinking during a routine primary care visit that took place between June 1st, 2013, and May 31st, 2014. The KPNC network serves 4.3 million adults (~1/3 of the Northern Californian population) and has systematically screened for heavy drinking in adult primary care with approximately 80% of its members successfully screened. The main outcome of this study was the cessation of heavy drinking. Screening for heavy drinking consisted of a medical staff member asking three questions: (1) ‘How many times in the past 3 months have you had five/four or more drinks containing alcohol in a day?’ for men aged 18-65 and men aged ≥ 66 or women respectively; (2) ‘On average, how many days per week do you have an alcoholic drink?’, and (3) ‘On a typical drinking day, how many drinks do you have?’. Heavy drinking was positive if a person exceeded either daily (5+ drinks for men aged 18-66 or 4+ for men aged ≥66 and women) or weekly limits (14 drinks/week for men aged 18-66 or 7 drinks/week for men aged ≥66 and women), based on the National Institute of Alcohol Abuse and Alcoholism (NIAAA) guidelines at the time of the initial screening. Early cessation of heavy alcohol use was defined as reporting lower-risk drinking (no heavy drinking days or weeks in the past 3 months) or abstinence at all screenings up to 1-year after the first positive heavy drinking screening. Sustained cessation of heavy alcohol use was defined as obtaining early cessation and reporting lower drinking or abstinence at all screenings up to the 5-year follow-up screening. Possible predictors were also collected and included socio-demographic characteristics, smoking status, drinking level (e.g., exceeding daily, weekly, or both daily and weekly heavy drinking limits), psychiatric disorders, alcohol and other substance use disorders, psychiatric or addiction treatment, routine (i.e., annual) primary care visits, and the type of early cessation (low-risk drinking or abstinence).
All enrollees that screened positive for heavy drinking during the index period (June 1st, 2013, and May 31st, 2014) were eligible to be included. During the 1-year eligibility period, 200,458 adults screened positive for heavy drinking. For each adult, all alcohol screens for the following 63 months were collected. The screenings closest to 1-year and 5-year post index screening were used for early and sustained cessation markers respectively. Approximately 46% of these patients were lost to follow-up due to death, disenrollment from Kaiser Permanente, or not having a 1 year screening, which resulted in 85,434 adults with observed alcohol use data that were used in the final analyses. Among those adults, 53,916 achieved early cessation and were eligible for the sustained cessation analysis, resulting in 19,200 adults with complete outcome data 5 years after index screening. The study accounted statistically for differences in attrition (i.e., likelihood of dropping out of the care during the study window).
Of the 85,434 adults in the analytical sample: 34,761 (40.7%) were females and 28,853 (33.8%) identified as non-white. The average age was 50.3 and 11,914 (13.9%) reported current smoking. Most – 50,193 (58.8%) – exceeded only daily drinking limits, while 20,835 (24.4%) exceeded only weekly limits and 14,406 (16.9%) exceeded both daily and weekly limits. There were also 4,057 (4.7%) adults who met criteria for an alcohol use disorder.
Most that screened positive for heavy alcohol use achieved early cessation.
A total of 53,916 (63.1%) adults that screened positive for heavy drinking achieved early cessation. Among those that achieved early cessation, 25,289 (46.9%) reported abstinence and 28,627 (53.1%) reported lower-risk drinking. Similarly, close to 2/3 (60.0%, 11,539) of the 19,200 that achieved early cessation and had outcome data reported sustained heavy drinking cessation.
Early cessation was more likely among females compared to males and those that did not identify as White.
The researchers found that several demographic characteristics and experiences were linked with higher odds of achieving early cessation. However, those identifying as female compared to male and/or Asian, Native Hawaiian, or Pacific Islander, Black, Latinx/Hispanic, or Native American compared to white were the strongest predictors.
Engagement in services (primary care and addiction treatment) was associated with sustained (5-year) cessation.
Among the 19,200 adults that achieved early (1-year) heavy drinking cessation, those that participated in routine (i.e., annual) primary care had a 57% increase in odds of achieving sustained (5-year) cessation compared to those that did not have routine primary care.
Surprisingly, individuals that attended psychiatric treatment within the first year after being identified with heavy drinking had lower odds of early cessation compared to those that did not. Moreover, adults that attended psychiatric treatment within the first year after positive heavy drinking screening did not differ in odds of achieving sustained cessation compared to those that did not attend psychiatric treatment. Attending addiction treatment, however, was associated with a 19% and 41% increase in odds of achieving early and sustained cessation respectively. Addiction treatment was one of the stronger predictors of sustained heavy drinking cessation.
Abstinence but not Alcohol use disorder diagnosis linked to early or sustained cessation.
Among all adults that screened positive for heavy drinking, 4.7% (4,057) were also diagnosed with an alcohol use disorder. Those with an alcohol use disorder diagnosis were no more likely or less likely to achieve early or sustained cessation of heavy drinking.
Adults that reported abstinence at 1-year were more likely to achieve sustained cessation compared to those reporting low-risk drinking. This effect was even larger among those with alcohol use disorder. For those with alcohol use disorder, abstinence was associated with 2.27 greater odds of sustaining cessation. For those without alcohol use disorder the odds ratio was the same as for the overall sample.
Nationwide, there are tens of millions of individuals that have resolved a substance use problem, and over half of those identify alcohol as the primary problem substance. However, most individuals do not seek or receive help for mild to moderate problematic drinking, highlighting the need to understand how individuals might resolve heavy drinking including. The need includes both those who do and do not attend treatment, and more importantly as it has been studied less often, how these individuals sustain this change over time. The researchers in this study explored what characteristics and behavioral health service utilization predict early (1-year) and sustained (5-year) cessation of heavy drinking. They found that 2/3 of adults that were identified through screening achieved early cessation of heavy drinking. This is higher than previous studies and suggests that screening during primary care may help identify alcohol problems before severity increases and link to needed treatments. Furthermore, the researchers found that routine primary care visits, independent of other factors, was the strongest predictor of sustained cessation. The impact of primary care may be especially useful for those without high severity drinking issues or alcohol use disorder. Primary care may be uniquely situated to address overall medical needs impacting drinking behaviors, identify and treat heavy drinking relapse, promote healthy lifestyles, and link to targeted services. It is also possible that attending routine primary care reflects a larger commitment to healthy lifestyle and some factors that were not measured are responsible for individuals’ drinking change and ability to sustain that change over time.
The type of early drinking cessation mattered for sustaining cessation. Those who reported abstinence at 1-year were more likely to achieve sustained cessation compared to those who reported lower-risk drinking. Previous research has shown that some individuals are able to drink and function as well as those that are abstinent in some domains such as psychological functioning, employment, life satisfaction, and mental health, the greater health risks of their heavier drinking notwithstanding. So, for some, lower risk drinking or lifestyle changes may be most appropriate. In this study, however, it was found that adults who reported abstinence at 1-year were more likely to report sustained cessation of heavy drinking after 5 years compared adults engaging in low-risk drinking. The long-term benefits of abstinence found in this study mirrors findings from the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), a nationally representative sample of U.S. adults. Researchers analyzing the NESCARC data found that abstinence represented the most stable form of remission from alcohol dependence compared to high- and low-risk drinkers after 3 years. Furthermore, researchers exploring a Dutch sample of adults also found that any alcohol use among those in alcohol use disorder remission was a significant risk factor for relapse to active alcohol use disorder. One contribution of the work done here is the inclusion of adults identified with heavy drinking behavior yet do not meet alcohol use disorder criteria; while showing that half of heavy drinkers stop drinking heavily through a low-risk drinking pathway, this study also highlights the greater stability of an abstinence approach to risk reduction and cessation of heavy drinking over time. This finding aligns with previous work highlighting the increased benefits of abstinence.
Two-thirds of adults that were able to be followed up in this study that screened positive initially for heavy drinking in this retrospective cohort study of primary care patients achieved early (1-year) cessation of heavy drinking and of those that achieve early cessation, nearly 2/3 reported sustained (5-year) heavy drinking cessation. Routine primary care was the strongest predictor of sustained cessation. Addiction treatment was also one of the stronger predictors of both early and sustained cessation. Abstinence was linked to higher odds of sustained (5-year) heavy drinking cessation, and this effect was even bigger among those with alcohol use disorder. This study explored the types of factors that predict cessation of heavy drinking as well as what factors predict its stability over time in a primary care sample of adults.
Palzes, V. A., Kline‐Simon, A. H., Satre, D. D., Sterling, S., Weisner, C., & Chi, F. W. (2022). Predictors of early and sustained cessation of heavy drinking over 5 years among adult primary care patients. Addiction, 117(1), 82–95. doi: 10.1111/add.15612
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