title: Alcohol consumption and symptoms as predictors for relapse of DSM-5 alcohol use disorder.
abstract: BACKGROUND
  Alcohol consumption levels and alcohol use disorder (AUD) symptoms may serve as easily quantifiable markers for AUD relapse after remission and might help prevention workers identify at-risk individuals. We investigated the predictive value of alcohol consumption and AUD symptoms on relapse.
  
  
  METHODS
  Data are from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). We selected 506 people in ≥12-month DSM-5 AUD remission at baseline and assessed their status at 3-year follow-up. AUD symptoms and drinking patterns were assessed using the Composite International Diagnostic Interview 3.0. Time since remission was assessed retrospectively at baseline and ranged from 1 to 48 years. Predictors for relapse were examined using Cox regression analysis.
  
  
  RESULTS
  Cumulative AUD relapse rate was 5.6% at 5 years, 9.1% at 10 years and 12.0% at 20 years. Relapse was predicted by both medium (15-28/22-42 drinks weekly for women/men) and high (≥29/43) past alcohol intake, 6+ lifetime AUD symptoms, 'impaired control over use', and at-risk (≥8/15) current intake. The risk of relapse was especially high when medium or high past intake or 6+ lifetime symptoms coincided with current at-risk drinking.
  
  
  CONCLUSIONS
  Only a minority of people in DSM-5 AUD remission relapsed, but the risk of relapse increased substantially with the presence of at least one of the risk factors. Moreover, at-risk current drinking coupled with other risk factors substantially increased the likelihood of relapse. Therefore, current drinking may provide an adequate reference point for relapse prevention.
authors.affiliation: Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands. Electronic address: mtuithof@trimbos.nl.
authors.forename: Marlous
authors.initials: M
authors.lastname: Tuithof
authors.affiliation: Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands.
authors.forename: Margreet
authors.initials: M
authors.lastname: ten Have
authors.affiliation: Department of Psychiatry, Academic Medical Centre, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: van den Brink
authors.affiliation: Department of Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands.
authors.forename: Wilma
authors.initials: W
authors.lastname: Vollebergh
authors.affiliation: Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology*; D000437:Alcoholism / Q000523:psychology*; D015331:Cohort Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006306:Health Surveys; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D055815:Young Adult
keywords: Alcohol consumption; Alcohol use disorder; DSM-5; Relapse; Symptoms