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Objective: A common clinical conception of alcohol dependence is that it is chronic, and the idea of impaired control figures prominently in an influential definition of alcohol dependence. We investigated the meaning of a diagnosis of DSM-IV alcohol dependence in untreated individuals. Method: Household residents screened for elevated drinking were assessed for DSM-IV alcohol dependence and reinterviewed 1 year later. We report on 115 subjects with and 460 subjects without current DSM-IV alcohol dependence at baseline. Follow-up drinking indicators included a measure of sustained reduction in drinking. Results: No support was found for a lower probability of sustained reduction in drinking at follow-up among the group with baseline DSM-IV alcohol dependence. Significant group differences indicated that the dependent group was more likely to reduce drinking. Conclusions: A diagnosis of DSM-IV alcohol dependence among untreated individuals implies a prognosis that is different from that for the same diagnosis among those seen in treatment settings. This does not necessarily indicate that the diagnosis is invalid, but rather suggests that risk factors for chronic course are more applicable to cases of DSM-IV alcohol dependence seen in treatment settings. (J. Stud. Alcohol 62: 509-517, 2001), ALCOHOL-RELATED MORBIDITY and mortality have long been significant problems in the United States. Alcohol-related traffic crashes and deaths from cirrhosis are among the most serious health consequences of excessive alcohol [...]

Objective: The clinical and research importance of tolerance and/or withdrawal in the diagnosis of substance dependence has been identified as a key area needing clarification. Earlier longitudinal studies did not identify whether diagnoses of alcohol dependence were current or lifetime. In this study, the prognostic significance of the DSM-IV physiological specifier was investigated among cases of alcohol dependence current at the baseline interview. The role of tremors, required in DSM-III and DSM-III-R, was investigated as well. Method: Household residents (N = 130; 57% men) meeting full criteria for current DSM-IV alcohol dependence in a baseline interview were re-interviewed a year later and DSM-IV alcohol dependence was again evaluated. Reliable structured interviews were used to make the diagnoses. The DSM-IV physiologic specifier and its components were tested as predictors of outcome of DSM-IV alcohol dependence, and included an additional definition of alcohol withdrawal that required tremors. Chi-square tests and adjusted odds ratios indicated statistical significance of group differences on outcome. Results: The DSM-IV physiological specifier (tolerance or withdrawal) did not predict 1-year chronicity of DSM-IV alcohol dependence, nor did tolerance when considered separately. However, withdrawal predicted poor outcome (e.g., 1-year chronicity of DSM-IV alcohol dependence). The effect of withdrawal was strengthened when tremors were required as part of the withdrawal syndrome. Conclusions: In contrast to earlier longitudinal research, this study supports the prognostic relevance of one component of the present DSM-IV psysiological specifier--withdrawal. Withdrawal appears to have stronger prognostic meaning when the DSM-III-R version, in which tremors were required, is used. Further studies of the physiological subtype may benefit from studying subjects who have been clearly identified at the baseline evaluation as having a current diagnosis of dependence. (J. Stud. Alcohol 61: 431-438, 2000), THE CLINICAL AND RESEARCH importance of alcohol withdrawal and tolerance in the diagnosis of alcohol dependence has been unclear for many years. Although the Feighner criteria (Feighner et al., 1972) [...]

ALCOHOL ABUSE was first formally differentiated from alcohol dependence with the publication of DSM-III in 1980 (American Psychiatric Association, 1980). At the time that DSM-III was published, the grounds for [...]

Objective: Little is known about the effects of contextual factors on the chronicity of alcohol dependence in the general population. Many adults in the United States live with others in a wide range of relationships. The drinking of household members was investigated as a potential risk factor for persistence of DSM-IV alcohol dependence in a prospective study of household residents. Method: At-risk drinking (five or more drinks on at least one occasion) in adult household members living with respondents was assessed at the time of the baseline interview for the index subjects in the study (N = 128; 56% men) who lived with other adults and who met DSM-IV criteria for current alcohol dependence. Index subjects' drinking and demographic variables were also measured at baseline. Approximately 1 year later, follow-up interviews determined the status of alcohol dependence in the 128 subjects. Results: Alcohol dependence was significantly more likely to be persistent among subjects with at-risk drinking among household members. Conclusions: The presence of other adult heavy drinkers in a household increased the risk of persistence of alcohol dependence in this community sample. Considerably more remains to he learned about the relationship and its treatment implications. (J. Stud. Alcohol 60: 769-775, 1999), CONTEXTUAL FACTORS have become increasingly important in the understanding of various behavioral phenomenon. Such a perspective is consistent with theoretical models that focus on factors external to the individual as [...]

Objective: Although a category for alcohol abuse has been included in the major nomenclatures since DSM-III, many questions have been raised about the definitions and validity of this category. Method: We investigated DSM-IV alcohol abuse in 628 at-risk drinkers residing in households who never met criteria for DSM-IV alcohol dependence at the time of a baseline interview. Cross-sectional and prospective longitudinal information were used. Results: Subjects most often met criteria for abuse with the single criterion, recurrent hazardous use (usually driving after drinking too much, on average 4.5 times per year). Younger and white subjects were more likely to receive the abuse diagnosis at baseline, as were drug users and those who drank five or more drinks per occasion frequently. Very few subjects received a diagnosis of DSM-IV alcohol dependence at follow-up, and those who did were equally likely to come from the abuse and non-abuse baseline groups. A current abuse diagnosis at baseline strongly and significantly predicted an abuse diagnosis at follow-up, although a past-only (remitted) abuse diagnosis at baseline was not clearly predictive of abuse at follow-up. Conclusions: The DSM-IV alcohol abuse category has some predictive validity. However, given the manner in which respondents met criteria for the disorder, its merits as a diagnostic category remain in question. Researchers should be cautious about combining alcohol dependence and abuse into the same category. (J. Stud. Alcohol 60:181-187, 1999), The validity of the concept of alcohol dependence as defined in DSM-III-R (American Psychiatric Association, 1987) and DSM-IV (American Psychiatric Association, 1994) has now been well-established through numerous studies with [...]