Types of alcoholics: concurrent and predictive validity of some common classification schemes

Abstract

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.

Clinical Variations of Adolescent Substance Abuse: An Empirically Based Typology

“…They reduced their drug use steadily between intake and 12 months, and maintained relatively low levels of internalizing and externalizing symptoms over the long term. Previous studies show that lower risk in terms of limited family alcohol and drug history, better family functioning, and lower levels of comorbid psychopathology predicts better treatment outcomes (Babor et al, 1992;Ball et al, 1995;Crowley, Mikulich, MacDonald, Young, & Zerbe, 1998) and less chronic substance abuse and related problems in adulthood (Duncan, Alpert, Duncan, & Hops, 1997). Although these youth are at elevated risk due to their juvenile justice involvement, these results corroborate findings from recent studies suggesting that drug abuse and delinquency may be discrete factors, and that the relationship between substance use and criminal activity among youth may be more dynamic than some have proposed (Farabee, Shen, Hser, Grella, & Anglin, 2001;Paradise & Cauce, 2003).…”

“…For instance, the parent's acceptance of and involvement with the adolescent interact with peer influences and individual risk factors such as emotional reactivity and feelings of low self-worth to predict both drug abuse and delinquency (Steinberg, 2001). The current study builds on this knowledge base by identifying and discriminating adolescent substance abuser subtypes based on three domains similar to those outlined by Babor et al (1992): individual and family risk factors, severity of substance use, and associated problems. To establish the predictive validity of the typology, the treatment outcomes of each identified subtype were examined.…”

“…Cloninger (1987) distinguished two genetically based subtypes of adult alcoholism: Type I alcoholics have later onset of problems and experience psychological rather than physical dependence, whereas Type II alcoholics have more serious, chronic alcohol use, earlier onset, and greater genetic liability for alcoholism. Babor et al (1992) established a similar two-group typology of adult alcoholics based on premorbid risk factors, pathological use of substances, and chronicity and consequences of drinking. Type A alcoholics have later onset of drinking, fewer risk factors, less severe problems, and better treatment outcomes than Type B alcoholics.…”

“…However, few of these typologies have demonstrated strong predictive validity in differentiating treatment responses or long-term outcomes. Babor et al (1992) suggest that classification schemes that are useful in predicting outcomes must be multidimensional in nature, taking into account the many individual and familial risk factors for substance abuse, the associated problems or consequences of use, as well as substance use severity. Further, an understanding of the variations in youth problem behavior must be rooted in an appreciation of the unique pathways of psychopathology and corresponding risk and protective factors that operate over the course of development (Loeber & Farrington, 1994).…”

Time-Varying Associations Between Conduct Problems and Alcohol Use in Adolescent Girls: The Moderating Role of Race

“…Caretakers completed the Alcohol Use Disorders Identifi cation Test (Babor et al, 1992), which is a 10-item measure assessing past-year quantity and frequency of drinking and alcohol-related problems using 3-and 5-point response formats. To assess lifetime antisocial behavior, caretakers completed the 46-item Antisocial Behavior Checklist-Lifetime (ABC-L; Zucker and Noll, 1980).…”