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Patterns of DSM-III-R alcohol dependence symptom progression in a general population survey

Published online by Cambridge University Press:  09 July 2009

C. B. Nelson ,
R. J. A. Little ,
A. C. Heath  and
R. C. Kessler
C. B. Nelson
Affiliation:
Institute for Social Research and the Departments of Epidemiology, Biostatistics and Sociology, University of Michigan, Ann Arbor, Michigan; Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, USA
R. J. A. Little
Affiliation:
Institute for Social Research and the Departments of Epidemiology, Biostatistics and Sociology, University of Michigan, Ann Arbor, Michigan; Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, USA
A. C. Heath
Affiliation:
Institute for Social Research and the Departments of Epidemiology, Biostatistics and Sociology, University of Michigan, Ann Arbor, Michigan; Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, USA
R. C. Kessler*
Affiliation:
Institute for Social Research and the Departments of Epidemiology, Biostatistics and Sociology, University of Michigan, Ann Arbor, Michigan; Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, USA
*
1Address for correspondence: Dr Ronald C. Kessler, Institute for Social Research, University of Michigan, Box 1248, Ann Arbor, MI 48106–1248, USA.
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Synopsis

Age of onset reports obtained retrospectively for each symptom of DSM-III-R alcohol dependence (AD) are used to study patterns of lifetime symptom progression in a large general-population survey of people in the United States. It is shown that symptom progression among a substantial majority of respondents can be summarized as movement across three clusters. Cluster A is defined by symptoms of role impairment/hazardous use (A4), use despite social, psychological or physical problems (A6), and drinking larger amounts or over a longer period of time than intended (A1). Cluster B is defined by tolerance (A7) and impaired control (A2, A3). Cluster C is defined by withdrawal (A8, A9) and giving up activities in order to drink (A5). Clusters are shown to follow a time sequence, with at least one symptom in Cluster A usually occurring first, followed by symptoms in Clusters B and C. In all, 83·4% of the symptom cluster transitions estimated from retrospective age of onset reports are consistent with this progression. Progression to AD is differentially predicted by symptom profiles reported at the age of first symptom onset, with persons reporting Cluster C symptoms most likely to progress subsequently to AD. Furthermore, profiles of AD defined by the highest symptom cluster present at AD onset are differentially predicted by prior personal and parental histories of psychopathology and, among men, are predictive of diagnosis persistence.

Type
Original Articles
Information
Psychological Medicine , Volume 26 , Issue 3 , May 1996 , pp. 449 - 460
Copyright
Copyright © Cambridge University Press 1996

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