Alexander DeLuca, M.D.
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Five-Year Clinical Course Associated With DSM-IV Alcohol Abuse or Dependence in a Large Group of Men and Women

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ABSTRACT

OBJECTIVE:
The prognostic validity of the DSM-IV diagnoses of alcohol abuse and alcohol dependence was evaluated by examining the 5-year clinical course associated with those diagnoses in a large group of predominantly blue-collar men and women.

METHOD:
Personal semistructured interviews were carried out 5 years after an initial evaluation with 1,346 (75%) of the approximately 1,800 men and women participating in the Collaborative Study on the Genetics of Alcoholism who were eligible for follow-up.

RESULTS:
About two-thirds of the 298 subjects with DSM-IV alcohol dependence at baseline maintained that diagnosis during the 5-year study period. Fifty-five percent of the 288 subjects with DSM-IV alcohol abuse at baseline continued to meet one or more of the 11 DSM-IV abuse/dependence criteria, and 3.5% went on to meet the criteria for dependence at follow-up. Among the 760 subjects with no alcohol diagnosis at baseline, 2.5% met the criteria for alcohol dependence and 12.8% for alcohol abuse at follow-up. Baseline characteristics that predicted the occurrence of any of the 11 DSM-IV abuse/dependence criteria during the 5-year interval included male gender, lack of marital stability, presence of several of the criteria for dependence, and history of illicit drug use.

CONCLUSIONS:
The data suggest that over 5 years the DSM-IV diagnosis of alcohol dependence predicts a chronic disorder with a relatively severe course, while DSM-IV alcohol abuse predicts a less persistent, milder disorder that does not usually progress to dependence. Are the diagnoses of alcohol abuse and alcohol dependence truly independent diagnoses? The authors examined the longitudinal course of these 2 disorders by examining 1346 individuals participating in the Collaborative Study on the Genetics of Alcoholism. The group was predominantly made up of blue collar, working class individuals who were administered, semi-structured interviews after the 5-year study period. The authors found that about two thirds of individuals meeting the criteria for alcohol dependence continued to meet this criteria after 5 years. Similarly, 55% of individuals with an alcohol abuse diagnosis continued to meet criteria for this diagnosis. Only 3.5% of individuals with a diagnosis of alcohol abuse progressed to having a diagnosis of alcohol dependence. Individuals with the abuse diagnosis seemed to have a milder disorder compared with those with a dependency diagnosis, which had a more chronic and disruptive course of illness. The authors concluded that abuse is not merely a prodromal step toward dependency and the 2 diagnoses are useful in their predictive value.
 

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