Predictors of 16-year mortality among individuals initiating help-seeking for an alcoholic use disorder.
METHODS
We examined rates and predictors of mortality in individuals (47% women) who had just initiated help-seeking for their alcohol use disorders (AUDs) at the start of the study (n=628) and were followed for 16 years.


RESULTS
For both women and men, the observed-to-expected mortality ratio (1.4) was lower than rates found in samples of treated individuals with AUDs, suggesting that those initiating help-seeking careers have better chances of long-term survival. Of the individuals for whom cause of death was known, 68% died of alcohol-related causes. Men were more likely to die than were women. When gender was controlled, individuals who were older and unmarried and had more alcohol dependence symptoms at baseline were more likely to die over the 16-year period. When these baseline characteristics were controlled, better drinking outcomes at 1 year were associated with a lower likelihood of subsequent death. The combination of a shorter duration of inpatient/residential care and better drinking outcomes at 1 year was related to a lower probability of death, as was the combination of a longer duration of outpatient care or Alcoholics Anonymous attendance and better drinking outcomes at 1 year.


CONCLUSIONS
Efforts should be made to help providers identify individuals who are not responding positively to inpatient or residential treatment and intervene to motivate participation in continuing outpatient care and community 12-step self-help groups to reduce the likelihood of a chronic and fatal AUD course.
Timko
Christine
C
Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford University Medical Center, Menlo Park, California 94025, USA. ctimko@stanford.edu
Debenedetti
Anna
A
Moos
Bernice S
BS
Moos
Rudolf H
RH
D000328:Adult; D019973:Alcohol-Related Disorders / Q000401:mortality* / Q000628:therapy*; D000436:Alcoholics Anonymous; D000437:Alcoholism / Q000401:mortality* / Q000628:therapy*; D000553:Ambulatory Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D012114:Residential Treatment; D012307:Risk Factors; D016896:Treatment Outcome