Investigating Factors Associated With Spontaneous Remission in Individuals With Alcohol Use Disorder—Results From a Multi‐Site Longitudinal Cohort Study

Alcohol use disorder (AUD) is considered a chronic disorder with a highly variable course. Understanding this variability is crucial for identifying factors associated with persistence versus spontaneous remission. We analysed data from N = 462 individuals with AUD in an observational longitudinal cohort study to identify factors associated with spontaneous remission. All participants met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for AUD at study entry and were reassessed after 1 year, in which they were classified as being in spontaneous remission (n = 107), falling below the ≥ 2-criteria threshold for AUD (n = 87) or continuing to meet AUD criteria (n = 296). Groups were compared on socio-demographic, clinical and substance use variables at baseline and after 1 year. Additionally, we used machine learning models to identify baseline characteristics predicting a persistent course of AUD. Between-group comparisons revealed that individuals who experienced spontaneous remission reported significantly lower AUD severity (F(2,459) = 25.17, p < 0.001), lower levels of alcohol intake (F(2,459) = 8.31, p = 0.013) and fewer drinking days (F(2,459) = 11.91, p < 0.001) at baseline and after 1 year. Machine learning analysis demonstrated moderate classification performance (AUC = 0.679), with the Alcohol Use Disorders Identification Test (AUDIT) sum score being the most informative predictor for group classification. Our findings indicate significant differences between spontaneously remitted and non-remitted individuals on key alcohol-related variables, supporting the clinical validity of remission as defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). In addition, baseline characteristics may help identify individuals at risk of persistent AUD, enabling earlier identification of those who may benefit from specialized treatment. TRIAL REGISTRATION: DRKS number: DRKS00020580.