Beyond remission: From alcohol dependence to optimal mental health

New research published online in the journal Substance Use & Misuse is good news for those struggling with alcohol dependence: the possibility of ending this dependency gets easier with age. Moreover, more than half of individuals who have been dependent on alcohol are free of any addictions or mental illness, and nearly 40% are in excellent mental health.

Using data drawn from Statistics Canada's Canadian Community Health Survey-Mental Health, researchers examined a nationally representative sample of 820 adult Canadians with a history of alcohol dependence to 19,945 who had never been addicted to alcohol.They found that in the past year, 71% of those with a history of alcohol dependence were no longer dependent; 52% were free of any addictions or mental illness, and 38% were in optimal mental health with high levels of happiness and social and psychological well-being.

"Past research has largely focused on remission from alcohol dependence—we sought to understand the whole continuum of recovery. We wanted to know what factors were associated with flourishing, not merely remission," says first author, Melissa L. Redmond, assistant professor of Social Work at Carleton University. "The high levels of resilience that we found are encouraging for those who are alcohol dependent, their family and loved ones and for professionals in the field."

Alcohol dependence is one of the leading causes of preventable deaths in the United States. Approximately 88,000 Americans die from alcohol-related causes every year, with nearly a third of all driving fatalities linked to alcohol-impaired driving. In the U.S, excessive alcohol use has been linked to close to 250 billion dollars in economic losses annually. Considering the personal, communal and economic consequences of alcohol dependence, there needs to be a greater understanding of factors associated with both remission and recovery—and corresponding improvements in mental health, relationships and quality of life.

Redmond and her colleagues found social support to be strongly associated with remission from alcohol dependence and achieving optimal mental health.

"We need to provide opportunities for healthy social integration and social support for clients who are working to overcome alcohol dependence," says co-author Anna S. Buhrmann, a research assistant at the University of Toronto. "A supportive circle of friends and family appears to be extremely important for the whole recovery trajectory."

Additionally, among those with a history of alcohol dependence, each decade of age was associated with more than 30% higher odds of remission from alcohol dependency and optimal mental health.

"With greater age, individuals often experience lower impulsivity, more family and work responsibilities, and a concomitant increased understanding of the negative impact that alcohol dependence has on quality of life, employment, family life and social relationships," says co-author Esme Fuller-Thomson, professor at the University of Toronto's Factor-Inwentash Faculty of Social Work and director of the Institute for Life Course and Aging. "Older individuals may have moved away from the social circles and alcohol dependent social situations of their youth, which would make decreasing alcohol use easier."

Positive outcomes were more common among married respondents and those who had never had major depressive disorders or generalized anxiety disorders. The strong link between a history of mental illness and worse recovery outcomes underline the importance of providing evidence-based interventions to address mental health as well as substance dependence issues.

While the Statistics Canada survey used for the study did not gather information on what interventions, if any, those with alcohol dependence received, other research indicates that brief interventions, motivational enhancement therapy and cognitive behavioral therapy, are quite successful in reducing alcohol use as well as dependence related symptoms.