Symptoms and characteristics of individuals with different types of recovery from DSM-IV alcohol dependence

Familial association of abstinent remission from alcohol use disorder in first-degree relatives of alcohol-dependent treatment-seeking probands

BACKGROUND AND AIMS

Studies that have included family history of alcohol use disorder (AUD) as a predictor of remission from AUD have yielded few significant results. The goals of this study were to estimate the association of persistent AUD, non-abstinent remission and abstinent remission ('AUD/remission status') in a proband with AUD/remission status in a relative and to test whether this association differed in related and unrelated proband-relative pairs.

DESIGN

High-risk family study of alcohol dependence. Probands were recruited from treatment settings and relatives were invited to participate. Baseline assessments occurred between 1991 and 1998 with follow-up between 1996 and 2005. Half of probands were matched with a biological 1st-degree relative with life-time AUD (related group) and half of probands were paired with an unrelated individual with life-time AUD (unrelated group).

SETTING

Brooklyn, New York; Indianapolis, Indiana; Iowa City, Iowa; San Diego, California; Farmington, Connecticut; and St Louis, Missouri, USA.

PARTICIPANTS

A total of 606 probands (25.7% female, mean age 37.7) with baseline and follow-up data and 606 of their 1st-degree relatives who had life-ime AUDs (45.8% female, mean age 36.2 years).

MEASUREMENTS

Persistent AUD, non-abstinent remission and abstinent remission were based on self-report interview data on most recent AUD symptoms and alcohol consumption. Dependent variable was relatives' AUD/remission status. Independent variable was probands' AUD/remission status.

FINDINGS

A total of 34.6% of probands and 20.6% of relatives were abstinent and 11.1% of probands and 22.8% of relatives were in non-abstinent remission. AUD/remission status was correlated significantly in related (r = 0.23, P = 0.0037) but not in unrelated pairs. A significant interaction of probands' abstinent remission with a variable representing related (versus unrelated, P = 0.003) pairs suggested a familial association for abstinent remission. In related pairs, individuals with an abstinent proband were more likely to be abstinent themselves than were individuals whose proband had persistent AUD [relative risk ratio = 3.27, 95% confidence interval (CI) = 1.56-6.85, P = 0.002]; this association was not significant in unrelated pairs.

CONCLUSIONS

The likelihood of abstinent remission among people with alcohol use disorder appears to be more than three times greater for individuals who are related to an abstinent proband versus those related to a proband with persistent alcohol use disorder.

Sociodemographic Factors and Comorbidities Associated with Remission from Alcohol Dependence: Results from a Nationwide General Population Survey in Korea

OBJECTIVE

The lifetime prevalence of alcohol dependence in South Korea remains higher than other countries. The aim of our study is to identify factors associated with remission from alcohol dependence.

METHODS

Data from the Korean Epidemiological Catchment Area-Replication (KECA-R) study were used in our study. The Korean version of the Composite International Diagnostic Interview 2.1 (K-CIDI 2.1) was administered. Remission was defined as having no symptom of alcohol dependence for 12 months or longer at the time of the interview. Demographic and clinical variables putatively associated with remission from alcohol dependence were examined by t-test, chi-square-test and logistic regression analysis.

RESULTS

The lifetime prevalence rate of alcohol dependence was 7.0%. Among them, 3.2% of the subjects were diagnosed with active alcohol dependence in the previous 12 months, and 3.8% were found to be in remission. Subjects in 35- to 44-year-old group, not living with partner group, and lower level of educational attainment group were more likely to be in the active alcohol dependence state. Of the comorbid mental disorders, dysthymia, anxiety disorder, nicotine use, and nicotine dependence were more common among the actively alcohol-dependent subjects.

CONCLUSION

There is considerable level of recovery from alcohol dependence. Attention to factors associated with remission from alcohol dependence may be important in designing more effective treatment and prevention programs in this high-risk population.

Limitations of DSM-IV Operationalizations of Alcohol Abuse and Dependence in a Sample of Australian Twins

Alcohol abuse and dependence are among the most common psychiatric conditions identified in epidemiological surveys of the general population. The aim of this article is to examine the psychometric properties of Diagnostic and Statistical Manual of Mental Disorders, (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria for alcohol abuse and dependence using latent class analysis (LCA). Six thousand two hundred and sixty-five young Australian twins (median age 30 years) were interviewed by telephone between 1996 and 2000 using a modified version of the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). DSM-IV symptoms of alcohol abuse and dependence were collected by structured diagnostic interview and analyzed using methods of LCA. LCA revealed a 4-class solution for women that classified individuals according to the severity of their alcohol- related problems: no/few problems (66.5%), heavy drinking (23.9%), moderate dependence (7.6%) and severe dependence (2.0%). Among men the preferred solution included 5 classes corresponding to no/few problems (46.4%), heavy drinking (34.3%), moderate dependence (12.2%), severe dependence (3.0%) and abuse (4.0%). Evidence of a male-specific class of alcohol-related problems corresponding to abuse partially supports the DSM conceptualization of alcohol use disorders but suggests that this conceptualization — and measurement — may need to be refined for women. Identification of a male- specific abuse class also has important implications for interventions and treatment as these individuals experienced significant alcohol-related problems and comprised approximately 21% of all men classified with an alcohol use disorder.

The Type A-Type B classification in a community sample of problem drinkers: structural and predictive validity

OBJECTIVE

The Type A-Type B multidimensional classification model has been useful for identifying a subgroup of alcohol dependent drinkers with more severe psychosocial problems and a poor prognosis. Evidence suggests its dimensions may be useful for identifying problem drinkers in the general population at risk for developing alcohol dependence. To date, the model has not yet been investigated for this purpose. The present study investigated the Type A/Type B distinction in a community sample of problem drinkers as well as its predictive validity among problem drinkers with no history of alcohol dependence.

METHOD

Households from a geographically delimited area in the United States were designated via random digit dialing and randomly designated members were screened for eligibility. A total of 876 participants met eligibility criteria and completed a structured interview (AUDADIS) on alcohol and other health related behaviors at baseline and at 1-year follow-up. A k-means cluster analysis was performed to identify subgroups of problem drinkers.

RESULTS

A two-cluster solution adequately fit the data and identified two main subgroups of problem drinkers consistent with a Type A-Type B distinction. The group differences held among those with and without a history of alcohol dependence and the subset of Type B drinkers with no history of alcohol dependence were approximately five times (beta = 1.56, p< or =0.01) more likely to have an initial onset of dependence than Type A drinkers at 1-year follow-up. In contrast, a DSM-IV alcohol abuse diagnosis at baseline did not predict 1-year onset of dependence.

CONCLUSIONS

The Type A-Type B model is useful for identifying untreated problem drinkers at risk for developing alcohol dependence. This model may facilitate the development of more targeted prevention efforts.

Alcohol abuse and dependence criteria as predictors of a chronic course of alcohol use disorders in the general population

AIMS

To investigate whether DSM-IV abuse and dependence criteria and the ICD-10 criterion for craving differentially predict a chronic course of alcohol use disorders (AUD) in the general population.

METHODS

Data were derived from the Netherlands Mental Health Survey and Incidence Study, a large representative sample of the general Dutch population with a baseline and a 1- and 3-year follow-up assessment. In the present study, a cohort of subjects with a DSM-IV AUD diagnosis at baseline was followed (n = 382). Diagnostic criteria of AUD according to DSM-IV and ICD-10 were assessed using the Composite International Diagnostic Interview (CIDI).

RESULTS

In our cohort of subjects with an AUD diagnosis at baseline, the presence of all dependence criteria, except tolerance, significantly increased the risk for dependence at 1 and 3 years follow-up. Abuse criteria displayed much lower and often non-significant risks for dependence at follow-up, with the exception of the criterion 'legal problems'. The ICD-10 criterion 'craving' had the highest relative risk (RR) of all criteria for dependence at 1 year (RR = 12.4, 95% CI = 5.5-27.8) and 3 years follow-up (RR = 12.9, 95% CI = 4.4-37.7).

CONCLUSION

With the exception of tolerance, all DSM-IV dependence criteria are useful in predicting the course of AUD in the general population.

Diagnostic compared with abstinence outcomes of day treatment and contingency management among cocaine-dependent homeless persons

Substance use disorder diagnoses were used as a treatment outcome measure in a randomized comparison of day treatment (DT) and day treatment plus contingency management (DT+) among homeless persons with primarily crack/cocaine disorders. Participants (N = 127, DT+ = 69, DT = 58, 73.2% male, 82.7% African American) were assessed at baseline and 6-month treatment completion. Binary positive and negative diagnostic outcomes for cocaine, marijuana, and alcohol were compared by treatment group. DT+ was 2.1 times more likely to have a positive treatment outcome than DT. Concordance between diagnostic change and point and continuous abstinence outcomes were found. The use of diagnostic change can be a practical addition to drug toxicology and self-report treatment outcome measures for research and practice.

Remissions from drug dependence: is treatment a prerequisite?

The present study investigated the prevalence of untreated drug remissions in a representative sample of respondents who had a lifetime diagnosis of one of five types of illicit drug dependence in the past (cannabis, cocaine/crack, hallucinogens, amphetamines, or heroin) but no diagnosis of drug abuse or dependence in the last year. It was concluded that, among recovered individuals with previous clinically significant drug concerns (as measured using DSM-IV criteria), a substantial proportion had accessed addictions treatment services prior to remission.