Natural history of male alcoholism. IV. Paths to recovery.

Four hundred inner-city men were prospectively studied from age 14 until age 47. Of these men, 110 met our research criteria for alcohol abuse; 49 of them achieved at least a year of abstinence. Paradoxically, stable abstinence was associated with severity of alcohol abuse. Abstinence was also associated with finding substitute dependencies, new relationships, "behavior modification," and religious or Alcoholics Anonymous involvement. Clinic treatment and good premorbid adjustment were not predictive of abstinence. Eighteen men were able to return successfully to problem-free drinking. Such men had previously manifested only a few symptoms of alcohol abuse.