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AUDs and Mortality

According to World Health Organization estimates, harmful use of alcohol caused 2.3 million premature deaths worldwide in 2002, or 3.7% of global mortality. The picture is equally bleak in the United States, where 4% of all deaths among men and 2% among women were attributable to alcohol.34 A review by Schuckit35 concluded persons with chronic AUDs have a risk of premature death that is 3-4 times that of the general population and that AUDs reduced life spans by more than a decade. The mortality toll among persons with AUDs is most commonly exacted by heart disease, stroke, and cancer. However, liver cirrhosis, accidents, and suicide also contribute to mortality.35-37

Fortunately, treatment for AUDs appears to reduce mortality risk. In a 16-year follow-up of a sample of treatment-naive adults who sought treatment for AUDs, Timko et al.38 found a standardized mortality ratio (SMR), or observed-to-expected mortality ratio, of 1.4, which is somewhat lower than the 1.6 to 4.7 ratios found in samples of individuals treated (usually more than once) for AUDs.39,40 Similarly, women who entered alcohol-related treatment in a specialized women’s program for the first time had a lower mortality rate for up to 25 years than did women from the same program who had more extensive treatment careers. However, the women treated for the first time still had a risk of death that was 2.4 times greater than women in the general population, and those who were younger (under age 40) had a mortality risk that was four times greater than that of women in the general population.

Better drinking outcomes following treatment are associated with a reduced mortality risk. In their 16-year study, Timko et al.38 found that individuals with more favorable drinking outcomes at a 1-year follow-up had a lower likelihood of subsequent death. The combination of a shorter duration of inpatient or 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 (AA) attendance and better drinking outcomes at 1 year. Likewise, among inpatients treated for AUDs who were followed for 16 years, those who had better treatment outcomes had a higher chance of survival.41 Similar results have been found among individuals treated in outpatient settings42 and those attending mutual-help groups.43

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