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The one-year intensive research training supported by the HHMI training programs appears to provide an effective imprinting experience on medical students' research careers and to be an attractive strategy for training physician-scientists.

This study evaluated the discriminative power and predictive validity of five common typological schemes used to classify alcoholics for theoretical or clinical purposes. A heterogenous sample of 321 alcoholics was classified according to primary vs secondary alcoholism, parental alcoholism, Fellinek's gamma-delta distinction, gender, and subtypes derived from MMPI profiles. A prospective longitudinal cohort design was employed to compare the relative ability of these typologies to differentiate alcoholics according to natural history, alcohol-related consequences, response to treatment, and post-treatment adjustment. The findings indicate that while 'one-dimensional' typologies discriminate subgroups in terms of etiological variables, presenting symptoms, and drinking patterns, none of the classification systems emerges as a strong predictor of outcome status. In addition, these typologies do not discriminate well with respect to the alcoholic's drinking patterns and presenting symptoms, except in areas closely connected with the model (e.g. alcoholics with antisocial personality (ASP) indicate more social problems related to alcohol use than do primary alcoholics). Because there is a great deal of overlap among certain subtypes identified within different typological models (e.g. alcoholics with primary ASP tended to have a positive family history and a gamma pattern of impaired control), we hypothesize that empirical clustering techniques that search for naturally occurring commonalities among alcoholics may be a better way to identify homogeneous subtypes.

Some but not all of the benefits resulting from short-term naltrexone treatment persist after discontinuation of treatment. The findings suggest that continued treatment with naltrexone may be beneficial for some patients.

Background Alcohol dependence often goes untreated. Although abstinence is often the aim of alcohol treatment, many drinkers prefer drinking-reduction goals. Therefore, if supported by evidence of benefit, drinking-reduction goals could broaden the appeal of treatment. Regulatory agencies are considering non-abstinent outcomes as clinical trial efficacy indicators, including reduction in the World Health Organization (WHO) drinking risk levels: very high, high, moderate and low, defined in terms of average grams of ethanol per day. Little is known about the relationship between reductions in WHO risk levels and subsequent reduction in the risk for alcohol dependence. Methods In a U.S. national sample, 22 005 drinkers participated in Wave 1 interviews in 2001–2002 and Wave 2 follow-ups 3 years later. Alcohol consumption and alcohol dependence were assessed at both waves. Logistic regression tested the relationship between change in WHO drinking risk levels between Waves 1 and 2, and Wave 2 alcohol dependence. Findings Reductions of 1, 2 or 3 WHO risk levels predicted significantly lower odds of alcohol dependence at Wave 2, particularly among very high and high risk drinkers at Wave 1, and among those with alcohol dependence at Wave 1. Interpretation Results support the use of reductions in WHO drinking risk levels as clinical trial efficacy indicators. Because the levels can readily be translated into average drinks per day using the standard drink equivalents of different countries, the WHO risk levels could also be used internationally to guide treatment goals and clinical recommendations on drinking reduction.