The 14-year course of alcoholism in a community sample: do men and women differ?

OBJECTIVE To investigate the course of alcoholism in males and females in a 14-year follow-up of persons with DSM-III alcoholism compared to very heavy drinkers and unaffected controls in a community sample. METHODS Case-control study based on data from the 1997 Health Services Use and Cost study, a 14-year follow-up survey of 442 individuals who participated in two waves of the 1981-1983 St. Louis Epidemiologic Catchment Area study. Cases met criteria for DSM-III alcohol abuse (AA) or dependence (AD) at both waves of the ECA: "Two-times Alcohol Use Disorder Positives (ECA 2t-AUDPs)." Two comparison groups were frequency matched to 2t-AUDPs: (1) ECA Very Heavy Drinkers/One-time Alcohol Use Disorder Positives (ECA VHD/1t-AUDPs) and (2) ECA alcohol-unaffecteds. Lifetime and past year alcohol use disorders, patterns of drinking and recovery among males and females are reported. RESULTS 84.6% of 2t-AUDPs again met lifetime DSM-III criteria at 14-year follow-up. At follow-up, only 9.3% male 2t-AUDPs and 20.7% female 2t-AUDPs met past year DSM-IV AUD criteria. Past year drinking patterns, however, revealed higher rates of DSM-IV AA or AD, problem or risk drinking among 2t-AUDPs (61.7%) compared to both ECA VHD/1t-AUDPs (41.2%) and ECA alcohol-unaffecteds (22.1%). CONCLUSIONS In a community sample, the rate of past year DSM-IV alcohol dependence was lower among male 2t-AUDPs than females, though both groups showed past year rates substantially lower than lifetime rates. However, less than half of ECA 2t-AUDPs exhibited low-risk or abstinent alcohol use behaviors, indicating that while remission from diagnosis is common, clinical relevance persists.