Studies on natural recovery from alcohol dependence: sample selection bias by media solicitation?

AIMS

To assess the selection bias of recruiting participants in studies on natural recovery from alcohol dependence through media solicitation.

DESIGN

Two samples with different recruitment strategies are compared.

SETTING

Media solicitation and general population.

PARTICIPANTS

Sample 1 consists of 176 alcohol-dependent individuals remitted without formal help and recruited through media solicitation, sample 2 consists of 32 natural remitters derived from a representative general population study with a sample size of 4075 respondents and a response rate of 70.2%.

MEASUREMENTS

Several triggering mechanisms and maintenance factors of remission were assessed in a personal interview using standardized questionnaires.

FINDINGS

Results of logistic regression analyses show that media-solicited subjects were more often abstinent in the last 12 months, were more severely dependent, were less satisfied with eight life domains prior to remission and showed higher scores in a coping behaviour measure. Besides these major differences from the multivariate analysis, media subjects revealed more health problems prior to remission, experienced more social pressure to change drinking behaviour, and showed differences in reasons for not seeking help.

CONCLUSIONS

Media solicitation leads to a sample selection bias in research on natural recovery from alcohol dependence. When measures to foster self-change are derived from such studies, findings from representative samples have to be considered.

[Health behavior of smokers--results of the TACOS (Transitions in Alcohol Consumption and Smoking) Study]

The German TACOS Project (Transitions in Alcohol Consumption and Smoking) provided an opportunity to examine the patterns of health behaviours (nutrition, physical activity, alcohol consumption) of current smokers, ex-smokers and non-smokers with special regard to different degrees of severity of nicotine dependence. Data were collected in the adult general population of Lübeck and 46 surrounding communities, resulting in a representative sample of 4075 individuals. In this sample, 37.3% were current smokers, 22.5% were ex-smokers, 25.0% of smokers were severely nicotine-dependent. As in other empirical investigations, current smokers had an unhealthy lifestyle in general. Smokers compared to ex-smokers and non-smokers consumed unhealthy foods more frequently, reported less physical activity and were more likely to consume hazardous levels of alcohol. Special attention was paid to comparing different degrees of severity of nicotine dependence. A high degree of nicotine dependence was associated with poor health behaviours. Data show that smoking, unhealthy nutrition, lack of physical activity, and hazardous levels of alcohol consumption occur in combination and that unhealthy behaviour patterns vary according to the severity of nicotine dependence. The presence of multiple unhealthy behaviours requires special secondary preventive interventions for smokers. The association of these combined health hazards must be controlled in determining the independent health risk due to one of these factors.

[Methods for quality assurance of medical examination in epidemiological field studies: the "Study of Health in Pomerania" (SHIP)]

The aims of the population-based, cross-sectional survey "Study of Health in Pomerania" (SHIP) are to describe prevalences and distributions of a broad range of diseases, as well as environmental and behavioural risk factors in the region of Pomerania (North-eastern Germany). The examinations are performed in two study units by different physicians, technicians and interviewers and laboratory analyses in two separate laboratories. In addition, the study will take at least 3 years and approximately 7000 persons will be examined. Because of the design of the study a special concept of quality assurance is indispensable. In the present paper methods are presented for quality assurance and control in anthropometry, ECG, echocardiography, abdominal sonography, carotid ultrasound, sonography of the thyroid gland, blood pressure measurements as well as clinical laboratory analyses. The technical control protocols, the training programmes of the observers and methods to establish observer and method variabilities are presented by means of typical examples. The logistic, personal and technical measures for quality assurance and control require appropriate attention. The methods and procedures presented here are expected to provide an effective instrument to continually monitor the quality of medical examinations in the SHIP study.

Inanspruchnahme von Hilfen zur Erlangung der Nikotin-Abstinenz

Das Ziel der vorliegenden Studie ist die Bestimmung der Inanspruchnahme von Hilfen zur Erlangung von Abstinenz bei Rauchern in der erwachsenen Allgemeinbevölkerung. Weiterhin sollen Raucher mit bzw. ohne Inanspruchnahme von Hilfen hinsichtlich des Rauchverhaltens, ausgewählter soziodemographischer Variablen sowie der Motivation zur Verhaltensänderung charakterisiert werden. Hierzu wurden 4075 Personen einer zu 70,2% ausgeschöpften Einwohnermeldeamtsstichprobe einer norddeutschen Region in einem persönlichen Interview befragt. Von allen befragten Rauchern, die jemals einen Abstinenz- oder Reduktionsversuch unternommen hatten, nutzten 14,3% irgendeine Form von Hilfen. Unter den verschiedenen Hilfen wurden nikotinsubstituierende Präparate (7,8%), Akupunktur (6,7%) und Entwöhnungskurse (1,9%) am häufigsten genannt. Derzeitige Raucher nahmen verglichen mit ehemaligen Rauchern häufiger Hilfen in Anspruch (19,0% bzw.8,5%). Inanspruchnehmer von Hilfen konsumierten im Mittel mehr Zigaretten, rauchten seit längerer Zeit, waren schwerer körperlich nikotinabhängig, erfüllten häufiger die Kriterien einer Nikotinabhängigkeit nach DSM-IV und befanden sich in Stadien einer erhöhten Änderungsmotivation. Weiterhin zeigte sich ein erhöhter Frauenanteil sowie ein höheres durchschnittliches Alter unter den Inanspruchnehmern von Hilfen. Die Ergebnisse werden im Hinblick auf zukünftige sekundärpräventive Maßnahmen diskutiert.

Inanspruchnahme suchtspezifischer Hilfen von Alkoholabhängigen und -mißbrauchern: Ergebnisse der TACOS-Bevölkerungsstudie

Ziel der Studie war die Erfassung von suchtspezifischen Hilfen für Alkoholabhängige und Alkoholmißbraucher in der Erwachsenenbevölkerung. Aus einer von den Einwohnermeldeämtern per Zufall gezogenen Stichprobe wurden 4075 Personen bei einer Ausschöpfung von 70,2% in einem persönlichen Interview befragt. Die Diagnosen Alkoholabhängigkeit und Alkoholmißbrauch nach DSM-IV wurden mit Hilfe des M-CIDI erhoben. Mit standardisierten Fragen wurden Inanspruchnahme suchtspezifischer Hilfen sowie Gründe für die Nicht-Inanspruchnahme von Hilfen erfragt. Bei Alkoholmißbrauchern ergaben sich sehr geringe Inanspruchnahmeraten, am häufigsten genannt wurde mit 5,4% die Beratung durch einen Arzt. Personen, die im Verlauf ihres Lebens eine Alkoholabhängigkeit gehabt haben, zeigten zu 59,5% keinerlei Kontakt zu suchtspezifischen Hilfen, bei 13,7% lagen geringfügige Kontakte und bei 26,8% weitergehende Hilfen vor. Mit 92,7% hatte ein großer Anteil Alkoholabhängiger mindestens einmal im letzten Jahr Kontakt zu Einrichtungen der medizinischen Versorgung, was für sekundärpräventive Maßnahmen in diesen Bereichen spricht.

Remission ohne formelle Hilfen und Inanspruchnahme stationärer Behandlung bei Alkoholabhängigen – Ein Vergleich auslösender Faktoren

Es werden Ergebnisse des Projektes »Transitions in Alcohol Consumption and Smoking« (TACOS) zur Remission ohne fremde Hilfe dargestellt. 230 ohne formelle Hilfe remittierte Alkoholabhängige werden mit 230 Patienten einer stationären Motivationstherapie hinsichtlich soziodemographischer und abhängigkeitsbezogener Variablen verglichen. Ohne formelle Hilfe remittierte Abhängige weisen anamnestisch eine schwerere Abhängigkeit, weniger sozialen Druck seitens der Familie und anderer Quellen und eine stabilere Beschäftigungssituation vor der Remission auf. Therapiepatienten haben häufiger und zeitlich näher am Therapiebeginn gescheiterte Abstinenzversuche erlebt. Die Unterschiede zwischen den Gruppen werden hinsichtlich ihrer Bedeutung für Sekundärprävention und Therapie diskutiert.

Estimating prevalence of alcohol abuse and dependence in one general hospital: an approach to reduce sample selection bias

Prevalence estimates of alcohol abuse or dependence in general hospitals are often limited to single wards, small data collecting periods or insufficient diagnostic procedures. Therefore, the present study aimed to ascertain alcohol abuse or dependence in one general hospital, to compare prevalence data for all the 11 wards and 6 intake months, to establish if screening is sufficient or if a two-step diagnostic procedure is needed, and to determine whether information for an alcohol diagnosis on suspicion is available. A sample of 1309 medical or surgical in-patients were screened by questionnaires or medication for withdrawal, and, if screening-positive, were interviewed with the alcohol section of a standardized psychiatric interview. In screening-negative patients, a diagnosis on suspicion was given if medication to treat withdrawal had been used, or if there was evidence of single criteria of alcohol dependence, somatic disorders from alcohol drinking, raised laboratory parameters on grounds of alcohol drinking or of self-reported high alcohol consumption. Of the medical and surgical in-patients, 20.7 and 16.0% respectively were alcohol abusers or dependents, with a range of prevalence rates of alcohol abuse or dependence among wards of 11.1-32.9% and among intake months between 11.3 and 28.7%. Of the medical department in-patients, 1.9%, and of the surgical in-patients, 2.1%, were screened as false-positive cases. In addition, 5.5% of the medical and 12.0% of the surgical patients were given a diagnosis on suspicion. It is concluded that all general wards and different intake months should be taken into account when estimating prevalence of alcohol abuse or dependence in a general hospital.

Contrast-enhanced sonography of vesicoureterorenal reflux in children: preliminary results

OBJECTIVE

The aim of our study was to evaluate contrast-enhanced sonography as an alternative to radiographic voiding cystourethrography in the detection of vesicoureteral reflux.

SUBJECTS AND METHODS

A total of 46 children, ranging in age from 3 weeks to 14 years (median: 4 years, 6 months) with 92 ureterorenal units were investigated for reflux using radiographic voiding cystourethrography and contrast-enhanced sonography in one session. After sonography of the urinary tract, the bladder was filled with saline solution via a catheter. Later, a contrast-enhancing agent was instilled and sonography was repeated. Documentation was done using S-VHS video and a laser camera. Reflux was diagnosed when microbubbles were observed in the ureter or in the renal pelvis. In addition, conventional voiding cystourethrography was performed. Patients without micturition during either sonography or radiographic examination were excluded (eight ureterorenal units).

RESULTS

The findings obtained by contrast-enhanced sonography and voiding cystourethrography were concordant in 78 ureterorenal units (92.9%). No reflux was detected in 67 units (79.8%) by either method. With voiding cystourethrography as the standard of reference, the sensitivity of contrast-enhanced sonography was 91.7%; the specificity, 93.1%; and the accuracy, 92.9%. The positive predictive value was 68.8%, and the negative predictive value was 98.5%.

CONCLUSION

Contrast-enhanced sonography is highly sensitive for the detection of vesicoureteral reflux. Therefore, it may reduce the number of radiographic investigations.

Motivation to change drinking behavior: comparison of alcohol-dependent individuals in a general hospital and a general population sample

The general hospital would be especially suited to initiate interventions if hospitalized alcohol-dependent individuals were particularly motivated to change their drinking behavior. This study compares the readiness to change of alcohol-dependent persons in the general hospital and the general population. Stages of change according to the model of Prochaska and DiClemente [6] are assessed using the Readiness to Change Questionnaire (RCQ) in two representative samples: 118 alcohol-dependent subjects admitted to a general hospital (sample 1) and 50 alcohol-dependent individuals in the general population (sample 2). In sample 1, alcohol-dependent persons were identified in 1167 consecutive admissions using screening questionnaires and a diagnostic interview (SCAN). In sample 2, alcohol dependence was assessed in 4075 individuals using a German version of CIDI. The distribution of stages of change differed significantly (p < 0.0001) between the groups, revealing a shift towards higher stages in the hospital subjects. Logistic regression analysis revealed that the stages of readiness to change and age contributed in predicting whether subjects belonged to the general hospital or the general population sample. Findings suggest that the general hospital is a suitable site to initiate interventions for alcohol-dependent individuals.

Drinking pattern and alcohol-related medical disorders

Although heavy alcohol intake is known to be one of the most common causative factors of liver disease, pancreatitis, upper gastrointestinal and neurological disorders, the influence of the drinking pattern is largely unknown. The study investigated the relationship of alcohol-related medical disorders in alcoholics and their drinking pattern. Two hundred and forty-one chronic alcoholics were referred consecutively for detoxification and their drinking pattern was sufficient for them to be included in this study. History of alcohol abuse as well as drinking behaviour in the last 6 months were assessed by a semi-structured interview. Findings included intensive clinical examination with abdominal ultrasound in most subjects. Heavy drinking with frequent inebriation was most often found in our sample (44.4%), whereas continuous heavy alcohol consumption without intoxication (33.6%), and an episodic drinking style (22.0%) were less frequent. The heavy drinkers suffered more often from pancreatitis, oesophageal varices, polyneuropathy or erectile dysfunction than episodic drinkers. They also showed more upper gastrointestinal disorders, although the estimated life-time alcohol intake was comparable to continuous drinkers. No difference relating to withdrawal delirium or seizures could be found between the groups of alcoholics. Frequent heavy drinkers showed a trend to more alcohol-related medical disorders than alcoholics with a different drinking pattern, although they were younger and their estimated life-time alcohol intake was comparable to that of continuous drinkers. Thus, the drinking pattern, particularly frequent inebriation, has an influence on the occurrence of alcohol-related disorders.

Differences between hospital patients with alcohol problems referred for counselling by physicians' routine clinical practice versus screening questionnaires

AIMS

To test the hypothesis that screening for alcohol-related disorders in a general hospital with questionnaires generates a target group of patients for alcohol counselling which differs from patients referred by physicians' routine clinical practice.

DESIGN

A prospective study with follow-up after 12 months.

SETTING

Medical and surgical wards of a general hospital.

PARTICIPANTS

A sample of 298 patients detected by screening questionnaires (CAGE, MAST) was compared with a sample of 87 patients referred by physicians.

MEASUREMENTS

The main measurements were a diagnostic interview (SCAN), two questionnaires to estimate the severity of dependence and the motivation to change drinking behaviour (RCQ, LAS), and socio-demographic variables. Outcome criteria were utilization of remedial programmes, decreases in hazardous and excessive drinking and abstinence rates.

FINDINGS AND CONCLUSIONS

Patients referred by physicians were more often separated and unemployed, were more likely to be alcohol-dependent and to be more severely dependent, had a higher rate of alcohol-related diseases as reasons for admission, were more often motivated to change drinking behaviour, had a higher participation rate in remedial programmes and more often exhibited improvements in drinking behaviour compared with the sample identified by screening questionnaires. However, there was evidence of improvements in drinking in both samples. Data show that while screening reaches a less problematic sample with lower motivation to change, it is a worthwhile activity which extends the spectrum of patients eligible for brief interventions.

Screening questionnaires in the detection of hazardous alcohol consumption in the general hospital: direct or disguised assessment?

OBJECTIVE

The aim of this study was to compare the validity of two direct screening questionnaires, the CAGE and MAST, in the detection of hazardous alcohol consumption with a disguised assessment by using the Trauma Scale in a poststratified general hospital sample.

METHOD

Surgical and medical inpatients (N = 1,379) completed the three questionnaires. Hazardous alcohol consumption was defined by criteria derived from a World Health Organization study and assessed using self-reported quantity and frequency.

RESULTS

The sensitivity of the Trauma Scale was not significantly different compared to the CAGE and MAST, whereas the direct questionnaires were higher in specificity and overall accuracy (p < .0001). In male surgical patients the detection rate of the Trauma Scale was higher compared to the CAGE (p < .05). Thirteen percent of subjects with hazardous levels of alcohol consumption were detected by the Trauma Scale only. In female surgical patients, the Trauma Scale, when used as an additional tool, does not improve the detection of hazardous drinkers.

CONCLUSIONS

Because of the low specificity, indirect assessment using a history of trauma cannot be recommended as a screening instrument in a general hospital setting. Despite a high number of false positives, the Trauma Scale may serve as an additional tool in conjunction with direct questionnaires when high sensitivity is desired.

[Stages of motivation to change in smokers of the general population]

Secondary preventive measures to reduce cigarette smoking can be effective only if the motivation to change in the target population is taken into account. A useful model to match interventions to the readiness to change differentiates five stages: precontemplation, contemplation, preparation, action, and maintenance. In the USA, general population studies showed that 40% of smokers were in the precontemplation and contemplation stage, respectively, and 20% were in the preparation stage. In Germany, no data according to the distribution of stages among smokers are available; however, such data are necessary to plan population-based interventions. Data with respect to nicotine use, nicotine dependence, and the stages of change were assessed in a representative sample of 4075 respondents in Luebeck, a northern German city, and 46 adjoining communities in a face-to-face interview. The response rate was 70.2%. In this sample, 37.3% were cigarette smokers. Of those smokers with at least one attempt to reduce or quite smoking in the past, 76.4% were in the precontemplation, 17% in the contemplation, and 6.6% in the preparation stage. Including individuals without an attempt to reduce or quit smoking, 95.3% can be allocated to the precontemplation or contemplation stage. Nicotine-dependent smokers were in higher stages compared to smokers without dependence. Severity of dependence was not related to the stages of change. Data demonstrate that common smoking cessation programmes that require the individuals' readiness to change are inappropriate for 95% of the population. Stage-matched interventions are introduced and discussed in the paper. Compared to data from the USA smokers in Germany are more likely to be in early stages of change. Policy-based public health measures are necessary to change these findings.

Kidney growth and renal function in unilateral multicystic dysplastic kidney disease

The natural history of multicystic dysplastic kidney (MCDK) is not well established. We analyzed kidney growth and renal function in 33 children with prenatally diagnosed unilateral MCDK in a long-term study. The mean observation period was 4.9 years with a range of 1-11.6 years. Abnormalities of the contralateral kidney were found in 10 of 33 patients (30%): ureteropelvic junction obstruction (5), ureterovesical junction obstruction (2), and vesicoureteral reflux (3). In 6 children the dysplastic kidney had been removed. Complete involution was observed in 48% and a decrease of size in 33% of 27 dysplastic kidneys. At the time of last examination, 27 of 29 children showed a volume of the contralateral kidney above the normal range (>145%). Hypertrophy of the contralateral kidney, defined as kidney length above 2 standard deviation scores (SDS), was seen in 24% of 33 children at birth, thus showing that hypertrophy of the contralateral kidney starts in utero and continues throughout childhood. The extent of contralateral hypertrophy was independent of associated abnormalities in this study. Mean creatinine was increased in the whole group (mean +1.13 SDS). Calculated creatinine clearance in 21 patients over 2 years was within normal limits, with a median of 102 ml/min per 1.73 m2 (range 84-143). Based on the results of this and previous studies, nephrectomy cannot be recommended in typical cases, but a regular follow-up of these patients seems necessary.

[Regional differences in the prevalence of high-risk alcohol drinking: secondary analysis of the East-West health survey]

Basing on a reanalysis of the public use file "Health Survey East and West Germany", the regional distribution of at risk alcohol consumption in Germany was examined in a representative sample of 7,466 adults. Substantial differences were seen in the prevalence rates between the German Federal Lands (provincial states), also if the social class, number of inhabitants of the community, unemployment as well as age and sex are statistically controlled. Besides a higher prevalence in the Eastern parts of Germany with the newly formed Federal Lands, there is a decrease in prevalence from south to north, mainly caused by the frequency of beer consumption. The results underline the importance of specific regional epidemiological data for public health-related interventions.

Clinical features of unilateral multicystic renal dysplasia in children

A clinical study of 204 patients with unilateral multicystic renal dysplasia referred to 30 nephrology departments was undertaken to assess the frequency of complications in children who underwent nephrectomy (n = 40) versus those who were treated conservatively (n = 164). Six patients required antihypertensive treatment, 30 (13% of girls, 17% of boys) had at least one episode of urinary tract infection. The number of clinical complications did not differ in patients who underwent nephrectomy in comparison to those who did not. The dysplastic kidney decreased in size in 65% of kidneys with repeated ultrasound values; no change occurred in 16%, while an increase in maximal diameter was observed in 19%. Contralateral kidney length of more than 2 standard deviation scores (SDS) was seen in 30% of patients. There is evidence for a slight impairment of renal function in the whole study group given by a median of serum creatinine level of 0.63 SDS in all patients available for analysis. Among those 35 patients with contralateral anomalies (mainly obstructive changes and vesico-ureteral reflux), all 3 patients with contralateral changes suggestive of hypoplasia and 22% with obstruction, but only 1/7 (14%) with reflux showed elevated serum creatinine level >2 SDS.

CONCLUSION

Renal function seems to be slightly impaired in patients with unilateral multicystic renal dysplasia. The apparent tendency to regression of the dysplastic kidney and no difference in the number of complications justify a conservative management rather than operative intervention.

Psychiatric co-morbidity, suicidal behaviour and suicidal ideation in alcoholics seeking treatment

AIMS

To estimate the impact of co-morbid disorders for suicidal ideas in alcohol-dependent subjects seeking treatment.

DESIGN

Life-time psychiatric co-morbidity and previous suicidal behaviours were assessed retrospectively after detoxification (t1). In addition, suicidal behaviours were assessed 12 months after discharge (t2).

SETTING

An inpatient detoxification treatment unit.

PARTICIPANTS

Two hundred and fifty dependent inpatients were studied after detoxification. One hundred and forty-nine of them participated in the follow-up face-to-face interviews.

MEASUREMENTS

Using two extended standardized interviews (CIDI and IPDE) psychiatric co-morbidity (DSM-III-R, Axes I and II) was assessed at t1; suicide attempts were reported at t1 and t2, and suicidal ideas were assessed at t2.

FINDINGS

A history of suicide attempts was reported by 29.2% at t1, and suicidal ideas by 14.1% and suicide attempts by 5.4% at the follow-up (t2). One female patient committed suicide within 6 months of discharge from hospital. The following co-morbidity patterns were associated with the greatest risk for suicidal ideas. Anxiety and depressive disorders, Axes I and 11 disorders, and a history of suicide attempt (for suicidal ideas at (t2). CONCLUSION. Our results underline the importance of psychiatric co-morbidity for the suicidal risk in alcohol-dependent patients, while alcoholism itself appears to be only a moderate risk factor.

Prevalence of alcohol dependence and abuse in general practice

The aim of this study is to deliver representative epidemiological data about the prevalence of alcohol abuse and dependence in general practices in an urban area. In 12 general practices at Luebeck, a Northern German city with 220,000 inhabitants, a total of 929 patients (aged between 14 and 75 years) were screened using the CAGE and the Short Michigan Alcoholism Screening Test. If one of these screening questionnaires or the General Practitioners' assessment of the patient indicated an alcohol problem, the patient underwent a standardized diagnostic interview using the alcohol section of the Schedules for Clinical Assessment in Neuropsychiatry. The prevalence rates according to ICD-10 or DSM-III-R were 3.5% for alcohol abuse and 7.2% for alcohol dependence, the sex ratio was 1:2.8 (female:male). These results are compared with previous findings, and general epidemiological implications of this study are discussed.

[Length of stay of patients with alcohol abuse or alcohol dependence in internal medicine and surgery]

To determine the length of stay (LOS) of alcoholic and non-alcoholic patients, all consecutive admissions to medical and surgical departments of a general hospital in Lübeck, Germany, were registered over a period of six months. The study sample comprised 625 medical and 661 surgical patients aged 18 to 64 years, 42% female. Alcohol abuse and dependence were detected using an expert interview (Schedules for Clinical Assessment in Neuropsychiatry, SCAN). The median LOS of patients with alcohol abuse or dependence was equal to that of the other patients (Z = 9 days). Differences occurred in the surgical clinic where alcohol abusers as well as alcohol dependent patients stayed longer than the others. There was significant trend in the medical clinic towards longer LOS for alcohol abusers and shorter LOS for alcohol dependent patients compared to the other medical patients respectively. Patients suffering from infections, tumors or gastrointestinal diseases had significantly increased LOS if having an alcohol problem. In conclusion, there is no general elongation of LOS in alcoholic patients. Differences occur if single departments or somatic or psychiatric subgroups of patients are regarded. However, high concentrations of alcohol-related diseases in these settings stress the importance of preventative measures.

Previous help seeking and motivation to change drinking behavior in alcohol-dependent general hospital patients

To assess the suitability of implementing secondary prevention approaches for alcohol abuse and dependence in the general hospital, it is worth examining how many problem drinkers are detected in this setting for the first time and whether these individuals are motivated to change their drinking behavior. In a representative general hospital sample (N = 1167), subjects were detected by a two-step diagnostic procedure including screening instruments and a diagnostic interview during a period of 6 months on all medical and surgical wards. Of alcohol-dependent patients, 38.2% had received no help in their lifetime and 70.8% did not seek help in the year prior to admission. According to the stages of change model of Prochaska and DiClemente the minority (10.9%) of subjects detected as alcohol dependent for the first time were not considering changing their drinking behavior (precontemplation stage); 84.8% were either in the contemplation or action stage. Previous help seeking showed no significant relationship with the stages of change.

Axis I and axis II comorbidity in alcohol dependence and the two types of alcoholism

BACKGROUND

Although high prevalence rates of psychiatric comorbidity were reported in alcoholism, there is a lack of studies covering the whole spectrum of DSM Axes I and II disorders. The relation of comorbid psychopathology and Cloninger's and Babor's types of alcoholism still remained unclear.

METHODS

Psychiatric comorbidity in 250 hospitalized alcohol-dependent patients without additional substance-related disorders was assessed by the Composite International Diagnostic Interview and the International Personality Disorder Examination. Information about the course and severity of alcoholism was obtained from several sources.

RESULTS

Additional Axis I disorders only were found in 24.0%, Axis II disorders only in 16.4%, and concurrent Axis I and Axis II disorders in 17.2% (total comorbidity rate: 57.6%). Two clusters of alcohol dependence were found that substantially overlap with Cloninger's and Babor's types of alcoholism. The majority of type A subjects were found to be either not comorbid at all, or to be Axis I comorbid only. Type B, on the other hand, was preferably associated with personality disorders (mainly Clusters A and B) and dimensional scores of personality pathology (schizoid, schizotypal, all Cluster B, and passive-aggressive).

CONCLUSIONS

The entire spectrum of personality pathology should be assessed in the comorbidity research of alcoholism. The two types of alcoholism differ on a variety of alcohol-related and comorbid personality characteristics, but further research is needed to clarify the underlying psychological and biological associations.