The Fate of Untreated Alcoholics

Sixty-two alcohol addicts who had been assessed in the Out-Patient Department of the Maudsley Hospital but had subsequently either refused treatment or been rejected as unsuitable were followed up after an average of 6.7 years. Eleven (18%) were found to have died, 5 (8%) by suicide; this mortality rate is 5 times higher than expected and the suicide rate 58 times higher than expected. Nine (15%) were found to have become abstinent; 6 of these had been treated in hospital elsewhere, and 2 had become members of Alcoholics Anonymous; only 1 had achieved abstinence unaided. Five (8%) were found to have returned to normal social drinking, 2 without any treatment or intervening period of abstinence. Twenty-five (40%) received treatment for alcoholism elsewhere during the follow-up period. The status of these patients at follow-up was very significantly better than that of the remaining 60%. The physical deterioration occurring during the follow-up period was not as serious as expected: of 6 with hepatic damage on initial examination, only 1 died of cirrhosis; of 11 with peripheral neuropathy, none developed serious disability; 2 others became demented and totally incapacitated and 2 developed Korsakoff states. The social deterioration was not marked probably because of the degree of initial deterioration: 5 more were divorced or separated, but 7 fewer unemployed; the average social stability and personal relationship scores changed little. There was a tendency for a good outcome to be associated with social stability and possession of a good relationship with some other person, and for a bad outcome to be associated with previous unsuccessful treatment. None of 11 other items studied (sex, age, duration and age at onset of excessive drinking, marital status, type of beverage, pattern of drinking, drinking environment, social class, history of delirium tremens or hallucinosis, attitude toward drinking) showed any correlation with outcome. The fate of the 49 patients who were regarded as suitable for treatment had they been willing was compared with the fate of 50 treated patients previously followed up for 4 years. Fewer patients in the untreated group became abstinent (8 vs. 11) or returned to normal drinking (4 vs. 5) and more died (9 vs. 3) or committed suicide (4 vs. I).