Course of remission from and relapse to heavy drinking following outpatient treatment of alcohol use disorder

Background: We sought to understand alcohol behavior change as a process over time by identifying patterns of relapse and remission after outpatient treatment and evaluating how these patterns predict longer-term clinical outcomes.

Method: We conducted latent profile analyses using data from the outpatient arm in Project MATCH. Relapse and remission episodes were defined by the number of consecutive 14-day periods that included any heavy drinking days and no heavy drinking days. Indicators of each profile were: initial 2-week post-treatment remission/relapse status, number of remission/relapse transitions in the first year after treatment, duration of remission episodes, and duration of relapse episodes.

Results: We identified 6 profiles: 1) "remission," 2) "transition to remission", 3) "few long transitions," 4) "many short transitions," 5) "transition to relapse," and 6) "relapse." Profile 1 had the best long-term outcomes. Long-term outcomes were not uniform among individuals with at least some heavy drinking (profiles 2 through 6; ∼75% of the sample). Individuals who transitioned back to and sustained periods of remission (profiles 2-4) had better long-term outcomes than those who failed to transition out of relapse (profiles 5-6) following treatment.

Conclusions: Post-treatment change in alcohol use is a process in which individuals variably transition in and out of "relapse" and "remission" statuses. "Any heavy drinking" following treatment is not necessarily a sign of treatment failure. A more nuanced look at the process of AUD change by considering whether individuals are able to transition to and sustain periods of remission seems warranted.