Jin H, Rourke S B, Patterson T L, Taylor M J, Grant I
Psychiatry Service, VA San Diego Healthcare System, California, USA.
J Stud Alcohol. 1998 Nov;59(6):640-6. doi: 10.15288/jsa.1998.59.640.
The goals of this study were to examine the hazard of relapse during an average 11 years of follow-up in alcoholics who had achieved long-term abstinence and to determine predictors of later relapse.
Male alcoholics (N = 77) with at least 18 months of stable abstinence at time of entry were followed for 2 to 17 years (mean follow-up = 10.9 years). During follow-up, detailed information regarding relapse/abstinence and interim drinking behavior was recorded. Potential predictors of relapse collected at enrollment included past drinking history, severity of alcohol-related life problems, degree of neurocognitive impairment based on neuropsychological (NP) tests, psychological distress (MMPI) and past medical health.
Twenty-four of 77 (31%) long-term abstainers relapsed during the follow-up period. The average annual hazard rate of relapse was 3.8% in the first 5 years of follow-up and 2.6% over the next 6-11 years. Based on Cox proportional hazard regression analyses, the only significant variables to predict relapse were MMPI Scale 4 (Psychopathic Deviate, relative risk = 3.16, 95% CI = 1.19-8.38) and prior history of alcohol-related life difficulty (i.e., citation for driving while intoxicated, relative risk = 2.64, 95% CI = 1.05-6.64) (chi2 = 14.2, 2 df, p < .001).
There is approximately a 3% annual risk of relapse in alcoholics who have been able to achieve long-term abstinence, even after 5 years of abstinence. Alcoholics who resumed drinking had greater indicators of longer standing psychological trait disturbance, reflected in elevated MMPI Scale 4 and history of more alcohol-related social difficulties. Placing the present study in the context of previous research that focused primarily on predictors or relapse in the shorter term, it appears that, whereas mood disturbance predicts short-term outcome, more enduring personality traits predict long-term success in remaining abstinent.
本研究的目的是调查长期戒酒的酗酒者在平均11年的随访期间复发的风险，并确定后期复发的预测因素。
入组时至少已稳定戒酒18个月的男性酗酒者（N = 77）接受了2至17年的随访（平均随访时间 = 10.9年）。在随访期间，记录了有关复发/戒酒及期间饮酒行为的详细信息。入组时收集的复发潜在预测因素包括既往饮酒史、与酒精相关的生活问题严重程度、基于神经心理学（NP）测试的神经认知损害程度、心理困扰（明尼苏达多相人格调查表，MMPI）以及既往健康状况。
77名长期戒酒者中有24名（31%）在随访期间复发。随访前5年复发的年均风险率为3.8%，接下来6至11年为2.6%。基于Cox比例风险回归分析，预测复发的唯一显著变量是MMPI量表4（精神病态偏差，相对风险 = 3.16，95%置信区间 = 1.19 - 8.38）以及既往与酒精相关的生活困难史（即因醉酒驾车被传唤，相对风险 = 2.64，95%置信区间 = 1.05 - 6.64）（卡方 = 14.2，自由度为2，p < .001）。
即使在戒酒5年后，能够实现长期戒酒的酗酒者每年仍有约3%的复发风险。恢复饮酒的酗酒者有更明显的长期心理特质紊乱指标，表现为MMPI量表4升高以及更多与酒精相关的社会困难史。将本研究置于先前主要关注短期复发预测因素的研究背景下，似乎情绪紊乱预测短期结果，而更持久的人格特质预测长期戒酒成功。
