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George E. Vaillant, MD

Arch Gen Psychiatry. 1996;53(3):243-249.

Abstract
Background
This study attempted to determine the course of male alcohol abuse from the age of 40 years to 60 or 70 years, to estimate the duration of abstinence required for stable remission and to study the hypothesis of progression of symptoms in chronic alcohol abuse.

Methods
The subjects were 268 former Harvard University (Cambridge, Mass) undergraduates (college sample) and 456 nondelinquent inner-city adolescents (core city sample) who had been repeatedly studied in multidisciplinary fashion since 1940. Since 47 years of age, these men have been followed up biennially by questionnaire and every 5 years by physical examination. At some point during their lives, 55 (21%) of the college and 150 (33%) of the core city men met DSMIII criteria for alcohol abuse. The college cohort has been followed until the age of 70 years, the core city cohort until age 60 years. The dependent variables were mortality and alcohol abuse status every 5 years.

Results
By 60 years of age, 18% of the college alcohol abusers had died, 11% were abstinent, 11% were controlled drinkers, and 59% were known to be still abusing alcohol. By 60 years of age, 28% of the core city alcohol abusers had died, 30% were abstinent, 11% were controlled drinkers, and only 28% were known to be still abusing alcohol.

Conclusions
In three respects the two socially divergent samples resembled each other. After abstinence had been maintained for 5 years, relapse was rare. In contrast, return to controlled drinking without eventual relapse was unlikely. Alcohol abuse could continue for decades without remission or progression of symptoms. The samples differed in that the core city men began to abuse alcohol when younger and, although they were more likely than the college men to become alcohol dependent, the core city men were twice as likely to achieve stable abstinence.

Author Affiliations
From Harvard Medical School and Brigham and Women's Hospital, Boston, Mass.

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