Abstract
Nine hundred and six members of a prospective longitudinal study were assessed for alcohol use disorder using a modified version of the Diagnostic Interview Schedule at ages 18 and 21 years. In order to qualify for a diagnosis of alcohol dependence, Study members had to display at least three of nine possible symptoms of the syndrome and at least two of these symptoms had to have persisted or recurred in the year preceding the interview. At age 18, 11.9% (n=111) were diagnosed as alcohol dependent and this increased to 18.3% by age 21 (n=175). 6.4% (n=58) were diagnosed as dependent at both ages. This study examined the question of whether chronicity of alcohol dependence (here defined as being diagnosed at both ages) was related to specific symptoms of the disorder or whether it was more appropriately viewed as a function of symptom accumulation. To assess the strength of the relationship between individual symptoms and a diagnosis of dependence, sensitivity and specificity were calculated for each symptom. At both ages, only two symptoms displayed both high sensitivity and specificity to the diagnosis of dependence: "use of alcohol when expected to fulfill major role obligations or when such use is physically hazardous", and "continued use of alcohol despite knowing it causes a social, psychological or physical problem". All other symptoms were either often reported by those not diagnosed as dependent (low specificity) or were frequently not reported by those diagnosed as dependent (low sensitivity). A comparison was made of the number of symptoms Study members reported at both ages. Study members who reported less than six symptoms at age 18 were most likely to report no symptoms at age 21. The next most common transition was to have the same number of symptoms at both ages. Study members who reported >6 symptoms at age 18 continued to report a similar high number of symptoms at age 21. Factor analysis of the symptoms revealed a two factor solution at both ages with the five most prevalent symptoms loading on the first factor, while the second factor was defined by the three least common symptoms. These results suggest a cluster of symptoms related to acute alcohol misuse and another cluster of symptoms more strongly related to chronic alcohol dependence in late adolescent and young adulthood. However, the relation between specific symptoms and chronicity of alcohol dependence appears to be largely mediated by the overall number of symptoms experienced by an individual.