The Natural History of Alcoholism Revisited (1995) is a book by psychiatrist George E. Vaillant that describes two multi-decade studies of the lives of 600 American males, non-alcoholics at the outset, focusing on their lifelong drinking behaviours.

The National Review hailed the first edition (1983) as "a genuine revolution in the field of alcoholism research" and said that "Vaillant has combined clinical experience with an unprecedented amount of empirical data to produce what may ultimately come to be viewed as the single most important contribution to the literature of alcoholism since the first edition of AA's Big Book.

"[1] Some of the main conclusions of Vaillant's book are: Core City: In 1940, Sheldon and Eleanour Glueck of Harvard began a major study of juvenile delinquency in teens from Boston — mostly poor kids in tenements, half without a bathtub in their homes.

In the 1983 edition of his book, Vaillant required four positive answers to questions on his Problem Drinking Scale (PDS) to indicate alcohol abuse.

The longitudinal method was useful in identifying factors in alcoholism, for instance by investigating whether delinquent behaviour started before or after drinking.

A prospective study takes a group of healthy individuals and tries to predict which ones would become alcoholic based on their histories—a much broader technique that often yields surprising results.

[16] Vaillant asserts that "Alcoholics are expert forgetters,"[17] have inaccurate memories,[18] and give persuasive denials[16] that manifest "an extraordinary ability to deny the consequences of their drinking.

[25] Vaillant compiled indicators of alcoholism from many sources, medical and sociological, and applied them to the Core City drinkers.

[29] In other words, it was equally valid to call alcoholism a medical or a behavioural disorder—evidence that doctors and sociologists are indeed talking about the same “unitary disorder”.

As the disorder worsens, conscious choice becomes less and less important and the alcoholic needs medical assistance to detoxify without risk to life (unlike, for example, heroin, which poses less physical danger to addicts going ‘cold turkey’).

[30] In this respect, alcoholism resembles coronary heart disease, which starts as ‘voluntary’, unhealthy behaviours such as poor diet and lack of exercise, but ends in a life-threatening medical condition.

Among the Core City subjects, 61% of whose parents were born in foreign countries,[36] alcoholics were seven times more likely to have Irish than Italian backgrounds.

Fewer alcoholics came from countries such as Italy that allowed children to drink, especially at meals, and looked down on adult drunkenness.

[44] Of 29 alcohol abusers in the College sample, seven men were able to drink heavily for a mean of three decades without showing symptoms of dependence.

"[47] Successful return to controlled drinking is possible, just a rare and unstable outcome that in the long term usually ends in relapse or abstinence, especially for the more severe cases.

At the end of the 8 years, 34% of subjects had achieved stable abstinence, 29% had died, and 26% were still abusing alcohol,[50] and the evidence was that other clinical studies had reported similar lack of success.

There was one indicator, a financial one, of short-term success: clinical intervention had significantly reduced the cost of future health care for the alcoholics.

Thus, achieving long-term sobriety usually involves Vaillant argues that an important contribution health professionals can make is to explain alcoholism to patients as a disease,[60] which encourages the patient to take responsibility for their problem without debilitating guilt, in the same way that a diabetic becomes responsible for proper self care when they become aware of their condition.

[69] Vaillant’s academic peers saw The Natural History of Alcoholism as “objective, scholarly, and factual,”[70] “wise” and “comprehensive”,[71] an “outstanding and highly recommended text”,[72] and “one of the few [longitudinal studies] and by far the most thorough and scientific.”[73] James Royce wrote that Vaillant "cites innumerable studies and examines opposing viewpoints on every issue," but that this objectivity made the book harder to read for the general reader since the conclusions were difficult to extract.

[77] Saunders held that more discussion of the treatment issues was needed and noted that many of the measurements made before Vaillant took over the studies were very crude.

In a 1983 review in The New York Times, Peele wrote that "The results of this research do not provide ready support for the disease theory of alcoholism.

Addiction researcher James E. Royce wrote that "Vaillant avoids a simplistic medical model of alcoholism, pointing up instead its complexity as a socio-psycho-biological illness.

"[80] David N. Saunders of the School of Social Work, Virginia Commonwealth University, wrote that Vaillant "maintains that alcoholism is both a disease and a behaviour disorder.