Lifetime Diagnosis Of Alcohol Dependence Research Articles

Reliability of lifetime drinking history among alcohol dependent men.

Information regarding patterns and correlates of problem drinking over the life course is important for both clinical and research purposes although few retrospective, psychometrically adequate instruments to collect data of this kind are available. In the current study, the authors report 5-year test-retest reliabilities of the Lifetime Drinking History (LDH). Analyses were based on 49 male participants with a lifetime diagnosis of alcohol dependence who were residing within intact families and who were not seeking treatment at time of initial assessment. Overall, the LDH was found to reflect adequate stability over this long retest interval for a number of relevant drinking measures, with results providing further support for the instrument's psychometric strengths. Limits on the generalizability of these findings and future research needs are discussed.

Drinking trajectories from adolescence to the mid-forties among alcohol dependent males.

Identifying differing developmental trajectories of alcohol behavior is fundamental in building theories of alcoholism etiology and course. The purpose of this study was to identify differences in developmental pathways of alcoholism from onset of drinking into middle adulthood. Alcohol-related behaviors and psychiatric status were assessed in 330 men from the Vietnam Era Twin Registry having a lifetime diagnosis of alcohol dependence (AD). Using a modified version of Skinner's Lifetime Drinking History, distinct drinking phases were identified that differed in terms of quantity, frequency and context of drinking. Person-year data were created to indicate whether AD criteria were or were not met for each year between drinking onset and age 41. Using Latent Growth Mixture Modeling, a four-class model was identified: Severe Chronic Alcoholics; Severe Non-Chronic Alcoholics (SNCA); Late Onset Alcoholics; and Young Adult Alcoholics. Counterparts for three trajectories could be found in the larger alcoholism literature, whereas the fourth type (SNCA) has not been described, notwithstanding its seeming importance and prevalence. Present findings support the existence of different alcoholism trajectories and provide a more complete understanding of the variability of alcohol dependence over time. Findings build on the larger alcoholism literature identifying alcoholic subgroups and provide important information regarding alcoholism trajectories and associated features. Future studies are needed with regard to better understanding of the psychosocial influences related to the different alcoholism trajectories, as well as characterizing the different trajectories as individuals transition into older age.

Long-term Stability of Alcohol and Other Substance Dependence Diagnoses and Habitual Smoking

A major criterion to validate diagnoses is stability over time. To examine the stability of several classification systems for lifetime diagnosis of alcohol dependence, to identify characteristics predicting stability of alcoholism, and to study stability of lifetime assessments of habitual smoking (1 pack per day for at least 6 months) and other drug dependence. Participants in the Collaborative Study on the Genetics of Alcoholism were interviewed using the Semi-Structured Assessment for the Genetics of Alcoholism and reevaluated 5 years later. Initial and follow-up interviews were available for 1728 individuals (641 index cases, 800 siblings, 287 controls) with lifetime diagnoses of alcohol dependence, other substance dependence (marijuana, cocaine, other stimulants, sedatives, opioids), or habitual smoking at first interview. The likelihood that an individual with a lifetime history of substance dependence or habitual smoking at the first interview retained this classification after 5 years was examined to assess stability of diagnosis. Stability of a lifetime diagnosis of alcohol dependence varied among the subject groups of index cases, siblings, and community-based controls. Alcohol dependence as defined by DSM-III-R criteria was highly stable in the index cases (90.5% women, 94.7% men) but much less stable in the community-based controls (27.5% women, 64.7% men). The most important characteristic associated with stability of diagnosis of alcohol dependence was severity, defined by the number of alcohol-related symptoms. Other DSM-III-R substance dependence disorders varied in the stability of diagnosis over a 5-year period. Lifetime history of habitual smoking was highly stable in all subject groups (96.0% overall). Stability of lifetime assessment of alcohol dependence varies depending on severity of illness. Severe cases of alcohol dependence are more likely to be stable, whereas general population cases of alcohol dependence are less likely to have stable diagnoses. The stability of diagnosis for other substance dependence varies from substance to substance.

Maturing out of drinking problems: perceptions of natural history as a function of severity

This study tested the hypothesis that maturing out descriptions of change were more common among respondents whose drinking problems were less severe prior to reduction and that consequence driven changes were more common among those who had a lifetime diagnosis of alcohol dependence, prior to resolution. As part of a general population telephone survey, former heavy drinkers were asked their reasons for change. These responses were tape-recorded, transcribed and then coded into three categories – consequence driven reasons, drifting out reasons and reflective maturational reasons. As predicted, drifting out reasons were more often provided by those with less severe alcohol use and consequence related reasons appeared associated with respondents who had had more severe alcohol problems. The differing descriptions of pathways to change observed in natural history studies may be the result of research that captures only partial samples of the larger population of former heavy drinkers.

Comorbidity of Select Anxiety and Affective Disorders With Alcohol Dependence in Southwest California Indians

Native Americans, overall, have the highest prevalence of alcohol dependence of any US ethnic group. In several large national surveys, alcohol dependence has been significantly associated with higher rates of anxiety and affective disorders (comorbidity). However, the frequencies of these disorders and their comorbidity with alcohol dependence in Native American populations are relatively unknown. Demographic information and DSM-III-R diagnoses were obtained by using the Semi-Structured Assessment for the Genetics of Alcoholism developed for the Collaborative Study on the Genetics of Alcoholism from 483 Southwest California Indian adults residing on contiguous reservations. The Semi-Structured Assessment for the Genetics of Alcoholism allowed differentiation of each anxiety and affective disorder into one of three types: independent of substance use, concurrent with alcohol use, and concurrent with drug use. Sixty-six percent of the men and 53% of the women sampled had a lifetime diagnosis of alcohol dependence. Fourteen percent of the sample had a lifetime independent anxiety disorder, and 14% of the sample had a lifetime independent affective disorder. Alcohol- and/or drug-concurrent major depression occurred in 8%, and other alcohol- and/or drug-concurrent anxiety and affective disorders each occurred in less than 1.1% of the sample. No significant comorbidity was found between alcohol dependence and independent agoraphobia, social phobia, or major depressive disorder. In this Southwest California Indian sample, rates of anxiety and affective disorders were substantially similar to those reported in the National Comorbidity Survey; however, comorbidity of independent disorders with alcohol dependence was not as pervasive as in the National Comorbidity Survey. Rates of concurrent anxiety and affective disorders were low. These data support the hypothesis that despite high rates of alcohol dependence, Southwest California Indians do not have higher rates of anxiety and affective disorders or comorbidity of these disorders with alcohol dependence than those reported in large surveys of non-American Indian populations.

Relationships between adult women's alcohol problems and their childhood experiences of parental violence and psychological aggression.

The objective of this study is to examine the associations between mother physical abuse, mother psychological aggression, father physical abuse and father psychological aggression and women's alcohol dependence while controlling for several demographic variables, childhood sexual abuse and mother and father alcohol problems. Samples of women in treatment for substance use disorders (n = 225) and receiving services for domestic violence (n = 222) volunteered to be in the study. We used the Parent-Child Conflict Tactics Scales to assess retrospectively experiences of parental aggression during childhood and the Composite International Diagnostic Interview for a diagnosis of alcohol dependence based on International Classification of Diseases (ICD-10) criteria. Logistic regression applied to the data showed that being in the substance use disorder treatment sample, being unemployed and not being black were significantly related to a higher likelihood of lifetime diagnosis of alcohol dependence. Mother psychological aggression was found to be significantly associated with alcohol dependence. Father psychological aggression was found to be significantly related to alcohol dependence for nonwhite women but not for white women. Mother and father physical abuse were both found to be significantly related to alcohol dependence, but only for women who did not report childhood sexual abuse. Associations between experiences of childhood abuse and development of alcohol problems for women are complex. Experiences of mother and father abuse need to be examined separately with samples of women who are of different ethnicities and samples of women who are receiving services for different problems.

Drinking course in alcohol-dependent men from adolescence to midlife.

Most studies of alcoholism course are based on clinical populations (characterized by severe and chronic alcohol-related problems) or community samples generally covering a short period of time. The current study assessed variations in drinking behaviors from adolescence to midlife in a community sample, describing age of "drinking firsts" (e.g., first alcoholic drink) as well as frequency and duration of periods of abstinence, alcohol dependence (AD) and nonproblem drinking. Participants were 354 males with lifetime diagnoses of AD (mean age 50.35) from the Vietnam Era Twin Registry who were assessed regarding alcohol use, abuse and dependence histories (DSM-IV). Using a modified version of Skinner's Lifetime Drinking History, drinking history was reported in terms of distinct drinking periods (phases). Participants reported, on average, 4.18 phases, each lasting 8.22 years, and 12.78 years of AD. More than 60% experienced increases in AD symptoms at least once in successive phases, but only a third of those increases were extreme. In contrast, extreme decreases in AD symptoms were reported by more than 50% of participants. Further, half indicated that they had transitioned from both fewer to greater and from greater to fewer AD symptoms during their drinking years; 8.2% reported no changes in AD symptoms. Results reflect a wide variation in drinking behaviors among AD men as well as frequent fluctuations in course within individuals' drinking histories. Findings do not support a universal developmental model of alcoholism; notably, they provide counterevidence to the disease model concept of alcoholism course as progressive and chronic.

Course of Alcoholism in Homeless Men in Munich, Germany: Results from a Prospective Longitudinal Study Based on a Representative Sample

In an earlier paper (Fichter, M. M., Quadflieg, N. (). Alcoholism in homeless men in the mid-nineties: results from the Bavarian Public Health Study on Homelessness. European Archives of Psychiatry and Clinical Neuroscience 249:34–44), we reported data on alcoholism and comorbidity in 265 homeless men in Munich. There—as in this paper—we divided the sample into three groups based on a lifetime diagnosis of alcohol dependence (N = 187), alcohol abuse (N = 17), and no diagnosis of alcoholism (N = 61) at baseline assessment. This study reports a three-year prospective longitudinal assessment of the original representative sample of homeless men in Munich. Interviews at baseline and at follow-up included the SCID-I and covered several other areas (cognitive impairment, somatic complaints, use of medical services, and other psychosocial variables). Of 247 homeless men still alive, at three-year follow-up, 185 (74.9%) were successfully traced and personally interviewed. Alcohol dependency in homeless men at first wave assessment (as compared to men not manifesting alcohol abuse or dependence) was associated with a higher proportion of homelessness at three-year follow-up, an increase of alcohol consumption at three-year follow-up, reduction of monthly income, higher death rate, and high use of general medical services but very low utilization of (specific substance) user treatment services. Alcoholism in homeless men constitutes a posited risk factor for an unfavorable course over time with regard to such a person's living situation and health status in spite of more utilization of medical services.

The effect of a history of alcohol dependence in adult major depression

We examined 180 patients with a principal diagnosis of Major Depression, with or without a lifetime diagnosis of alcohol dependence. In the ever-dependent group, the GAF was lower; cannabis dependence higher; and Borderline, Schizotypal and Paranoid personality disorders more common. They reported more paranoia and interpersonal sensitivity on the Hopkins Symptom Checklist and more friction and interpersonal behaviour on the Social Adjustment Scale. On the Temperament and Character Inventory, novelty seeking was higher and persistence and cooperativeness lower. PBI scores and family histories did not differ significantly. Treatment outcome did not vary, except that subjects with lifetime alcohol dependence and current heavy drinking did less well.

Exploring Patterns of Remission from Alcohol Dependence with and without Alcoholics Anonymous in a Population Sample

Narratives provided by former heavy drinkers have indicated that respondents who attended AA experienced more abrupt resolutions than respondents who never attended AA. This study explored the extent to which this difference in resolution pattern exists in a representative sample of individuals remitted from a lifetime diagnosis of alcohol dependence.

Event‐related potentials and comorbidity in alcohol‐dependent adult males

The present study examined event-related potentials (ERPs) elicited by a visual discrimination task in a community sample of adult males with a lifetime diagnosis of alcohol dependence. Study participants were subtyped by the presence of additional comorbid disorders (antisocial personality, depression, and drug abuse or dependence). In all groups of alcohol-dependent subjects, even those without any additional comorbid disorders, P3 amplitude differed from that of a comparison group. Alcohol-dependent subjects with a diagnosis of illicit drug abuse or dependence, especially if they had antisocial personality as well, had the smallest amplitude responses. The amplitude profile of the P3 across the parietal electrodes used as active sites was flattened among alcoholic subjects, with P3 amplitude disproportionately reduced at the midline. Among alcoholic subjects with a lifetime diagnosis of depression, the flattened amplitude profile was due to elevated mean amplitude of the P3 at lateral leads, especially P4, relative to the comparison group. Alterations in ERP responses appear to be a general characteristic of alcoholism in men, although the presence of other comorbid disorders, particularly drug abuse or dependence together with antisocial personality, results in the greatest reductions in P3 amplitude.

Effects of Age and Parental History of Alcoholism on EEG Findings in Mission Indian Children and Adolescents

Many, but not all, Native American tribes have some of the highest rates of alcohol abuse and dependence. Yet, risk factors for the development of problem drinking in these high risk groups remain largely unknown. In primarily Euroamerican populations, electrophysiological variables have been associated with risk for alcoholism. The EEG has a specific developmental time course that has been described in a diverse set of ethnic groups, but it has not been described in Native American youth. In addition, the relationship between EEG development and risk for alcoholism in Indian youth has not been previously studied. Clinical ratings and spectral characteristics of the resting EEG were investigated in 140 Native American Mission Indian children and adolescents between the ages of 7 and 13 years. The specific aims of the study were to (1) investigate the relationship of age and gender with EEG spectral variables to determine if this population conforms to similar trends from previously published data in other ethnic groups and (2) to determine whether children with a parental history of alcoholism differ from those without alcoholic parents on EEG spectral parameters. No excess of abnormal EEG activity was found in this sample of Native American youth. Age, but not gender, was found to have a significant effect on EEG spectral characteristics with younger children (7-11 years old), having significantly more power in slow activity (0.5-7.5 Hz) and in alpha power (8-12 Hz) as well as slower alpha frequencies than older children (12-13 years old). Consistent with other studies of Native American youth, 66% of the children and adolescents participating in this study had at least one parent who had a lifetime diagnosis of alcohol dependence. However, an ANCOVA that covaried for age and gender revealed no significant differences in power or frequency characteristics of the EEG on the basis of parental history of alcoholism. These studies suggest that this sample of Mission Indian children, despite high levels of parental alcohol dependence and low socioeconomic status, show normal EEG development. As yet, no relationship has been found between any specific EEG phenotype and parental history of alcoholism in this population, however, further EEG maturation may be necessary before any relationships can be fully delineated.

Cognitive impairment among methadone maintenance patients.

To compare the cognitive performance of methadone maintenance patients (MMPs) and a matched sample of non-heroin-using control subjects, and to ascertain risk factors for poorer cognitive performance. Matched control study. Sydney, Australia. Thirty MMPs and 30 non-heroin using controls, matched for age, gender and education. The MMP group had significantly higher rates than controls of alcohol dependence, heroin overdose and head injury. There was no difference between the groups on pre-morbid functioning. The MMP group performed significantly poorer than controls on all of the neuropsychological domains measured: information processing, attention, short-term visual memory, delayed visual memory, short-term verbal memory, long-term verbal memory and problem solving. A life-time diagnosis of alcohol dependence and the number of non-fatal heroin overdoses were independent significant predictors of poorer cognitive performance. In addition to high rates of psychiatric morbidity, MMPs also show cognitive deficits compared to matched controls. A history of alcohol dependence and repeated exposure to overdose increase the likelihood of cognitive impairment. The current study does not rule out the possibility of other factors, that were not measured, that may contribute to cognitive impairment among this MMPs.

The impact of sociodemographics, comorbidity and symptom recency on health-related quality of life in alcoholics.

To obtain estimates of the relationship between alcoholism and health-related quality of life (HRQL) in twin pairs discordant for alcohol dependence. In 1995, 1,258 male-male twin pair members of the Vietnam Era Twin Registry (total Registry N = 7.375 pairs) were administered a modified Medical Outcomes Study 36 Item Short Form (SF-36) and the Diagnostic Interview Schedule (DIS) to obtain measures of HRQL and a DSM-III-R criteria lifetime diagnosis of alcohol dependence. Mean within pair differences on eight separate SF-36 subscales were calculated for 436 remitted (no alcohol symptoms in the past 5 years) alcohol-dependent discordant twin pairs and for 194 recent (at least one alcohol symptom in the past 5 years) alcohol-dependent discordant pairs before and after adjustment for covariates. Covariates included lifetime physical illness, lifetime psychiatric disorders, lifetime drug dependence, lifetime nicotine dependence, current marital status, current income and severity. In the unadjusted analysis remitted alcoholic twins compared to their nonalcoholic co-twins reported significantly lower mean scores for six of eight SF-36 subscales. Recent alcoholic twins, compared to their nonalcoholic co-twins, reported significantly lower mean scores for all of the SF-36 subscales. However, after simultaneous adjustment for all covariates, no SF-36 subscale mean, except "vitality" among recent alcoholic twins, was significantly different between alcoholic twins and their nonalcoholic co-twins. Differences in HRQL between alcoholic and nonalcoholic co-twins is due to covariation from physical and psychiatric problems, drug and nicotine dependence, marital status, income and severity.

Type 1 and type 2 alcoholics (Cloninger & Bohman) have different patterns of successful long-term adjustment.

SummaryFifty‐five socially well adjusted male alcoholics and 29 male alcoholics with a disability pension, all having a life‐time diagnosis of alcohol dependence (DSM‐III), were personally followed up 2 decades after their first admission to hospital. Among the socially well adjusted subjects, type 1 and type 2 alcoholics, as defined by Cloninger et al., 13 differed significantly concerning drinking patterns at the follow‐up with a higher frequency of stable sporadic abuse (‘atypical abuse’) and a lower frequency of abstinence and social drinking in the type 2 alcoholics (p<.01). The stability of improvement and the psycho‐social functioning at the follow‐up did not differ between atypical abusers, social drinkers and abstainers.