Five Years Is Magic Number for Recovering Alcoholics

Attempts at social drinking frequently lead to relapse

By William J. Cromie

Gazette Staff

Harvard alumni and others who became alcoholics were not likely to return to drinking if they remained sober for five years, according to a Medical School study.

In the longest investigation to date, researchers tracked 268 Harvard graduates and 456 poor, inner-city men from adolescence to age 60-70 years. While the economically disadvantaged drinkers were more likely to become alcoholics, they were twice as likely as the college men to kick the habit. By age 60, 59 percent of the Harvard group still abused alcohol, compared to 28 percent of the inner-city men.

Forty percent of those who managed only two years of abstinence eventually went back to the bottle.

"After five years of sobriety, however, relapse was rare," notes George Vaillant, professor of psychiatry, who headed the research. "Before this study no one knew how long an alcoholic has to be sober to be cured."

The study concludes that it is difficult, if not impossible, for men who abuse alcohol to return to social drinking. "Of 21 men who returned to social drinking after age 40, all but five relapsed before they went five years without abusing alcohol," Vaillant noted.

"Liberal-minded people are upset by the idea that Alcoholics Anonymous (AA) and other groups insist you must remain abstinent," Vaillant said "It's an ongoing controversy, but this study supports the AA point of view. If you follow former abusers long enough, you see that most of the social drinkers relapse."

Education Doesn't Help

Vaillant, who directs psychiatric research at Brigham and Women's Hospital, took over the study 30 years ago after the men had already been tracked for 25 years. He found that the Harvard men began alcoholic abuse later than the poor, inner-city males and experienced fewer problems.

"Socially disadvantaged men, in part as a function of early onset of severe alcohol dependence, often become stably abstinent," Vaillant explained. "However, because of poor health habits (especially smoking and diet) they are more likely to die [sooner].

"On the other hand, alcohol abusers with excellent social supports, high education, good health habits, and late onset of alcohol abuse are more likely to survive and to maintain a pattern of lifelong intermittent alcohol abuse. Thus, the college men, despite their educational and social advantages, were less likely to abstain from alcohol abuse."

By age 60, 18 percent of the Harvard alcohol abusers had died, compared to 29 percent of inner-city men. Thirty-two percent of the latter group were abstinent compared to 11.5 percent of the college men.

Surprisingly, after 5 to 15 years of worsening symptoms, the severity of alcoholism leveled off. "After age 40, instead of progressing, it is rather like chronic obesity -- it doesn't get better, it doesn't get worse," Vaillant commented.

Alcohol, directly or indirectly, kills 100,000 people in the United States each year, according to the study, published in the March issue of Archives of General Psychiatry. Also, the risk of heart disease and cancer is twice as high for alcohol abusers than for nonabusers, and heavy smoking dramatically increases the death rate among abusers.