Onset and staging of DSM-IV alcohol dependence using mean age and survival-hazard methods.

Abstract

Orderly onset of psychiatric symptoms has implications for both case detection and the construct validity of the underlying illness. Mean age and survival-hazard techniques were used to study the onset of alcohol abuse and dependence (as defined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders; American Psychiatric Association, 1994) in 369 clinical cases drawn from a heterogeneous regional sample. The methods provided a similar general pattern of symptom sequencing, though only survival-hazard analysis described a punctuated onset of alcoholism in 3 discrete stages: alcohol abuse, dependence, and accommodation to the illness. This model survived a rigorous program of tests for goodness of fit and described the majority of the sample, supporting the construct validity of both alcohol abuse as a discrete first illness phase and of dependence as a set of core constructs distinct from and succeeding abuse. The specific strengths of survival-hazard analysis as a research tool in illness staging research are discussed.

Impaired Control and Undergraduate Problem Drinking

“…Specifically, results of the present study, establishing that the ICS predicts problem drinking cross-sectionally in young adults with relatively brief drinking histories, further support the position that impairment of control is one of the earliest stages of addiction (Chick and Duffy, 1979;Langenbucher et al, 1995;Martin et al, 1996;Winters et al, 1999). By the time later stages are reached (e.g., withdrawal and alcohol-induced psychological or physical problems), risk of relapse increases (Witkiewicz and Marlatt, 2004), making treatment more difficult.…”

“…Impaired control is not only an important element of addiction in general, it is of particular relevance to young adults and others with relatively brief drinking histories given its early emergence. Heavy drinking adolescents often report impaired control, as have adults with problem drinking histories who were asked to recount which of their dependence symptoms developed the earliest (Chick and Duffy, 1979;Langenbucher and Chung, 1995). This is in contrast with DSM-IV dependence criteria like withdrawal and alcohol-induced physical or psychological problems (APA, 1994), which typically require lengthy drinking histories and are rarely reported by adolescents (Martin et al, 1996;Winters et al, 1999).…”

Prospective Relations Between Bulimic Pathology, Depression, and Substance Abuse: Unpacking Comorbidity in Adolescent Girls.

“…These aims were addressed with data from a community-recruited longitudinal study of adolescent girls because this developmental period is a high-risk time for onset of substance abuse (Langerbucher & Chung, 1995), depression (Hankin et al, 1998), and eating pathology (Stice, Killen et al, 1998), and because bulimic pathology is rare among males.…”

Relationship of Substance Abuse to Dependence in the U.S. General Population

“…Regardless of whether DSM-III-R (American Psychiatric SAHA ET AL. 369 Association, 1987) or DSM-IV criteria were used, those studies consistently indicated the presence of two correlated but distinct factors.Previous studies have identifi ed considerable overlap between DSM-IV criteria for abuse and dependence (Langenbucher and Chung, 1995;. Even factor analytic studies that report two-factor models do not yield complete differentiation between abuse and dependence criteria Harford and Muthén, 2001;Muthén, 1995).…”