Physiological alcohol dependence as a "specifier" of risk for medical problems and relapse liability in DSM-IV.
OBJECTIVE
This study tested the ability of DSM-IV physiological alcohol dependence to predict multiple indices of medical problems and relapse behavior. It also tested the ability of three additional variables--DSM-IV nonphysiological dependence, an alternative dichotomous criterion for coding physiological dependence and a dimensional measure of physiological dependence--to predict medical problems and relapse behavior in alcoholism.


METHODS
A heterogeneous group of 365 patients was recruited from eight addictions treatment programs in the northeastern United States. A multidimensional assessment battery able to diagnose the presence of physiological dependence according to each of three systems--the criteria of DSM-IV, alternative dichotomous criteria and a dimensional scale-- was administered about 2 weeks after admission, and 241 subjects were reinterviewed 6 months later. The three systems were compared for their ability to predict a variety of external measures of medical complications and relapse liability.


RESULTS
Physiological alcohol dependence as diagnosed by DSM-IV bore no relationship to either risk for medical problems or relapse behavior. Further analyses showed that this failure was due to operational problems of physiological dependence in DSM-IV, rather than to a lack of conceptual merit for physiological dependence per se as a course specifier. Use of alternative criteria for coding physiological dependence which are difficult and less internally consistent, and use of a dimensional measure, found improved relationships with the external validators.


CONCLUSIONS
Contrary to early reports, physiological dependence can serve as a course specifier for alcohol problems, but must be more sensitively scaled than it was in DSM-IV. Tests of alternative options suggest that a multistage criterion to replace DSM-IV's dichotomous criterion is the best remedy.
Langenbucher
J
J
Center of Alcohol Studies, Rutgers University, Piscataway, New Jersey 08855-0969, USA.
Chung
T
T
Morgenstern
J
J
Labouvie
E
E
Nathan
P E
PE
Bavly
L
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000430:Alcohol Withdrawal Delirium / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation; D000437:Alcoholism / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000534:rehabilitation; D000465:Algorithms; D015331:Cohort Studies; D004361:Drug Tolerance / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome