Age of Onset as a Discriminator Between Alcoholic Subtypes in a Treatment‐Seeking Outpatient Population

Abstract

Subtyping alcoholics may provide a more accurate guide as to the course and character of the disease. Classifications of different ages of onset of problem drinking have so far resulted in categorical inconsistencies. In the past, hospital-based alcoholics have over-represented those most severely ill, and comprehensive evaluations of psychopathology for discriminating between alcoholic subtypes have been infrequent. In a heterogeneous treatment-seeking, outpatient, alcoholic population, we tested the hypothesis that age of onset represents a continuum of disease, and that greater severity of psychopathology is associated with lower ages of onset. Using a standard questionnaire, 253 male and female treatment-seeking alcoholics were stratified according to specific ages of onset: a) < 20 years; b) 20-25 years, and c) > 25 years. These age of onset groups were compared on alcohol severity and craving, family history, childhood behavior, personality, hostility, overt aggression, mood, and social functioning. Symptom severity and age of onset were negatively correlated, and the 20-25-year onset group usually had intermediate scores. The < 20 year onset group was characterized by greater severity of alcohol-related problems, family history, childhood behavioral problems, craving, hostility, antisocial traits, mood disturbance, and poor social functioning. Alcoholics with an earlier age of onset have relatively greater psychopathology than those of later onset. While the preponderance of psychopathology among those in the < 20-year onset group could be conceptualized as a clinical "subtype," such a characterization would not define an entirely homogeneous category. Yet, this clinical characterization would be clinically important if specific age of onset levels were found to be differentially sensitive to pharmacological and/or psychological treatments.

Physical and Mental Health and Social Functioning in Older Alcohol-Dependent Inpatients: The Role of Age of Onset

“…As alcohol dependence is often a chronic or relapsing disorder, age of onset is, after adjustment for age, inversely related to illness duration: an older patient with EOAD will have accumulated a larger number of years of heavy alcohol consumption than an older patient with LOAD or VLOAD [11]. This was also true in our study sample, and this makes it even more significant that comorbidity was similar between our VLOAD group and the other two groups.…”

“…The fact that there were no group differences in difficulty to control aggression is surprising, because the literature indicates that antisocial personality traits are a hallmark of EOAD [8,11]. However, symptoms of antisocial personality disorder are likely to gradually diminish with age with eventual remission after age 50 [32].…”

“…Many other authors have proposed other classification systems, with two, three or more subtypes of alcohol dependence [6,7,8,9,10]. The various typologies show similarities and differences, which renders comparison between the studies a complicated venture, that has yielded inconsistent results [11]. One of the more robust features that are shared between most of the typologies is the age of onset of alcohol dependence.…”

Typologies of Alcohol Dependence. From Jellinek to Genetics and Beyond

“…The 4 ug/kg twice daily dose of ondansetron was the most efficacious though not statistically superior to the other doses. Baseline data from a cohort of the same sample treated with ondansetron described above were analyzed by the same research group (Johnson et al 2000b). This analysis revealed that characteristics defining the early onset AD patients included higher rates of childhood risk behaviors, hostility, impaired social functioning, and increased number of male relatives with AD, somewhat comparable to Cloninger's Type II, and Babor's Type B subtypes (Johnson et al 2000b).…”

No Reliable Evidence That Emotional Disorders Are Proximal Antecedents, Concomitants, or Short-Term Consequences of First Episode Alcohol Use Disorders in a Representative Community Sample

“…It is possible, however, that AUDs occasioned by stress or negative emotion are more common among older individuals. Existing research has been mixed as to whether emotional problems are more common among those with earlier versus later AUD onset ages (e.g., Cloninger, 1987;Johnson et al, 2000). Consequently, the generalizability of findings observed here to those with initial AUD onsets after age 30 is uncertain.…”