Middle-aged and older adults with alcohol dependence whose goal is abstinence from drinking are least likely to relapse among age-matched peers, but sustained recovery may be less likely for younger people regardless whether their goal is abstinence or restricted consumption, according to an article in the December issue of Alcoholism: Clinical and Experimental Research.

"The biggest surprise was how little abstinence did to improve the prospects for younger alcoholics remaining in remission. To my knowledge, no one has looked at this age differential before," said lead study author Deborah Dawson, PhD, a substance abuse researcher with the National Institute on Alcohol Abuse and Alcoholism.

The article examined results from the U.S. National Epidemiologic Survey on Alcohol and Related Conditions.

Dawson and colleagues analyzed recovery status of more than 1,700 adults who were in some form of recovery at the beginning of the study, but who had been dependent on alcohol in the past.

Researchers grouped the participants into three categories: 1) abstainers, people who said they did not drink alcohol; 2) low-risk drinkers, people who drink at levels lower than those thought to increase risk for relapse; and 3) asymptomatic risk drinkers, people who do not have any symptoms of alcohol abuse or alcohol dependence but who drink more than the recommended guidelines for low-risk drinking.

The team interviewed study participants in 2001 and 2002, then again in 2004 and 2005.

Adults who were abstainers at the beginning of the study were most likely to still be in recovery - and symptom free - at the second wave of the survey. Fifty-one percent of the asymptomatic risk drinkers had experienced recurrence of alcohol dependence symptoms compared with 27.2 percent of low-risk drinkers and 7.3 percent of abstainers.

"The most commonly reported symptoms of dependence in this study were repeatedly trying to stop or cut down on drinking, drinking more or for longer than intended and problems with sleeping, nausea or restlessness when the effects of alcohol were wearing off," Dawson said. "The most commonly reported abuse symptom was driving after drinking too much."

Abstinence worked best for alcoholics older than 25 years, the study found. The benefits of abstinent recovery were not as strong for younger individuals. "Youthful abstainers are still at high risk," Dawson said.

It is not clear why abstinence does not work as well for young drinkers, but the authors said the high risk for relapse among people age 18 to 24 years begs for more study and signals a significant treatment and prevention challenge for the legal system and for college campuses.

Health researcher Lee Ann Kaskutas said it was too soon to discount the benefits of abstinence for young alcoholics.

"It may be that these very young drinkers just haven' t lived long enough - or had time to experience the cycle of failure and success - to allow abstinence to work,"said Kaskutas, director of training at the Alcohol Research Group in Berkeley, Calif.