Predictive value of alcohol dependence symptoms for the course of dependency: A Swedish cohort study

Abstract Background Alcohol dependence (AD) is a major public health issue, contributing substantially to the global burden of disease. While traditionally considered chronic, recent evidence suggests that AD may not always be persistent. This study aimed to investigate the association between symptoms of AD and risk of 1-year persistence of AD among adults in Sweden. Understanding these associations is essential for developing targeted prevention and treatment strategies. Methods Data stem from a Swedish general population survey (ages 17-84), with 7072 participants followed 2013 - 2014. AD was assessed via DSM-IV criteria. Latent class analysis (LCA) was used to identify subgroups based on symptom patterns. Poisson regression estimated associations between persistence of AD and (1) individual AD criteria, (2) the number of criteria fulfilled (severity), and (3) latent classes derived from symptom combinations. Results Risk of 1-year persistent AD increased with number of criteria fulfilled (RR = 1.28, 95% CI: 1.19-1.37). Specific symptoms associated with higher persistence risk included Withdrawal (RR = 1.50, 95% CI: 1.19-1.89), Quit/control (RR = 1.63, 95% CI: 1.27-2.10), Activities given up (RR = 1.43, 95% CI: 1.14-1.80), and Physical/psychological problems (RR = 1.54, 95% CI: 1.08-2.19). LCA revealed 3 classes with varying severity and symptom profiles; the class with high probability of endorsing five or more symptoms had the highest risk of persistent AD. All results are preliminary. Conclusions Both severity and specific symptom patterns of AD can help predict its short-term course. These findings can inform early intervention efforts by identifying individuals at elevated risk within the general population. The study supports the notion that AD is not invariably a stable condition, highlighting the potential for change and recovery. Key messages • Severity and specific AD symptoms predict 1-year persistence. • Findings support the non-chronic nature of alcohol dependence