Analysis
We entered and analyzed data using custom programs written in Microsoft Access (Microsoft, Redmond, Washington), a relational database which enabled us to classify the content of open-ended responses and to determine the frequency of common themes across questions. Microsoft Excel was used to calculate chi-square values according to Siegel’s formula.18
Results
The subjects were well distributed among the third through sixth decades of life Table 1. Women outnumbered men 3 to 2. Most subjects had private insurance, were well educated, and were married or remarried. The demographic attributes of the study subjects and the nonresponders were similar (chi-square tests, P >.05).
The subjects’ AUDs had been active for an average of 11.3 years (standard deviation [SD] =9.0 years, range=1-40 years). The disorders were in remission for an average of 11.1 years (SD=7.8 years, range=0-32 years). Subjects experienced their first alcohol-related symptoms at an average age of 19.3 (SD=5.4, range=10-50 years). The average age for their first attempt at quitting or cutting down was 27.5 years (SD=8.5 years, range=16-53 years). The average age for their most recent attempt at quitting or cutting down was 31.8 years (SD=10 years, range=16-56 years). The majority of subjects (57.9%; N=69) made only one attempt to quit or cut down; 32.7% (39) made 2 to 5 attempts; and 4.2% (11) made 6 or more attempts. One subject reported 20 attempts at quitting or cutting down; another reported 100 attempts. More than two thirds (N=81) of the subjects drank in the past month, and 79.8% (95) drank in the past year. Subjects who continued to drink did so on an average of 3.0 days in the past month (SD=4.4 days, range=0-30 days). Nearly half of the subjects (N=54) drank on 1 to 4 occasions in the last 30 days, and 31.9% (38) did not drink at all. Approximately half of the subjects (N=60) had alcohol dependence in remission, and half (59) had alcohol abuse in remission.
Table 2 shows subjects’ responses to many of the closed-ended questions of the study. Approximately two thirds (N=79) made a conscious decision to quit or cut down; for the remainder, the reduction in drinking occurred without intent.
Table 3 shows the subjects’ specific answers grouped by the major themes that emerged from our analysis of their responses. Within each theme, there were responses reflecting both positive and negative reasons to modify drinking. For example, one subject mentioned that he changed his drinking pattern to be a better role model to children; another stated that she changed because of family disapproval.
Thirty-six subjects initially planned to cut down on their drinking; the others attempted abstinence. A total of 10.9% (13) of the subjects underwent formal alcohol treatment, and an additional 1.7% (2) received help from other professionals. A total of 15.1% (18) attended self-help groups, such as Alcoholics Anonymous.
Thirty-six subjects identified at least one specific strategy that helped them modify their drinking. Thirteen mentioned that it was helpful to avoid bars and people who drink. Others mentioned that it was helpful to change their social activities (N=9), follow the rules of Alcoholics Anonymous (7), keep busy (6), and keep no alcohol at home (5). A total of 12.6% (N=15) tried strategies that did not prove helpful, such as limiting the occasions they went out (5), quitting “cold turkey” (3), avoiding peer pressure (2), and going to Alcoholics Anonymous meetings (2).
Nearly one third (N=39) of the subjects made rules for themselves about their drinking. The most frequently mentioned rules involved limitation. Examples were limits on the amount of alcohol permissible to consume on a particular occasion and limits on the number of days per week or times of the day in which drinking was allowed. Three of those who made rules failed at attempts to quit “cold turkey” by using will power or by “taking control.” Two subjects felt that the 12 steps and other rules of Alcoholics Anonymous were not helpful, and 2 felt that avoiding drinkers was not helpful.
A total of 16.8% (N=20) of the subjects stated that certain circumstances in their lives prompted them to modify their drinking. The most frequently mentioned circumstances were medical conditions and medications that were not compatible with alcohol (N=4). Others mentioned a religious experience (N=3) or the death or injury of a friend or family member (3). Ten of the subjects cited circumstances that hindered their efforts to modify their drinking. Such unfavorable circumstances included obligated exposures to others who drink and peer pressure (N=7), divorce and other family stress (4), and depression (1).