Drinking by alcoholic cirrhotic patients under medical care: a literature survey.

In order to gain a broader perspective on the natural course of drinking by alcoholic cirrhotic patients receiving medical care, the medical and surgical literature from 1963 through 1982 was surveyed for prospective studies of patients with alcoholic cirrhosis in which follow-up drinking data were reported. Eleven studies with 1,039 patients were summarized. The patients were mostly urban men, averaging about 50 years old, treated in municipal, Veterans Administration, and university hospitals for either decompensated cirrhosis or for portal hypertension and bleeding varices; follow-up periods ranged from less than 1 to 10 years. The clinical investigators in the studies used various means to assess drinking and to categorize drinking behaviors, and expressed caution regarding validity. Between series, from 20 to 53% of the patients were reported to be abstinent from alcohol during the clinical follow-up periods. In five studies (373 patients) where the extent of drinking was determined, from 21 to 35% of the patients were reported to be drinking in a reduced or moderate manner, and from 17 to 42% to have resumed heavier drinking. The rates of improvement in drinking reported for the cirrhotic patients under medical care compare favorably to those for middle-aged male clients after alcoholism treatment, but the variables that predict course and outcome cannot be fairly compared between "medical" and alcoholism treatment populations. The substantial reduction or cessation of drinking reported in these large series of alcoholic cirrhotic patients over long follow-up periods may simple represent the natural, terminal course of alcoholism in the presence of severe liver disease; concomitantly, improvement may reflect the favorable impact of an alcohol-related disease and continued medical care on changing drinking behaviors.