title: Severe alcohol-induced liver disease and the alcohol dependence syndrome.
abstract: OBJECTIVE
  To examine the hypothesis that patients who present in the UK to detoxification services differ from patients who present with severe alcohol-induced liver disease (ALD) with respect to severity of dependence on alcohol and other features of their drinking history.
  
  
  METHODS
  Levels of alcohol dependence were assessed in 34 patients with severe ALD, all of whom were cirrhotic, and 34 subjects from a residential alcohol detox centre in Southampton using the Severity of Alcohol Dependence Questionnaire (SADQ). During interview, various aspects of participants' alcohol consumption were recorded, including total monthly consumption, whom they usually drank with and where, and, if applicable, what caused them to start drinking heavily. Social circumstances were also noted, including participants' employment and marital status.
  
  
  RESULTS
  Among ALD patients, 58% scored none/mild on the SADQ, 32% moderate and 9% severe. In contrast, 76% of the detox group were graded severe and 34% moderate (P < 0.001). ALD patients were also significantly older, had lower scores on the Alcohol Use Disorders Identification Test, tended to drink less alcohol, were more likely to be in a stable relationship, were less likely to be unemployed and gave different reasons for starting to drink heavily. The ALD group were most likely to have started drinking heavily for social reasons, whereas subjects in the detox group were most likely to have started drinking heavily as a result of relationship or money problems.
  
  
  CONCLUSIONS
  Patients attending a liver unit and patients admitted to a detoxification unit were separate but overlapping populations of alcohol misusers. Perhaps these two populations of alcohol misusers are likely to require different approaches for effective detection, intervention and treatment.
authors.affiliation: Liver Unit, University of Southampton Medical School and Southampton University Hospitals Trust, UK.
authors.forename: Stewart
authors.initials: S
authors.lastname: Smith
authors.forename: Joanna
authors.initials: J
authors.lastname: White
authors.forename: Chris
authors.initials: C
authors.lastname: Nelson
authors.forename: Marianne
authors.initials: M
authors.lastname: Davies
authors.forename: Joanne
authors.initials: J
authors.lastname: Lavers
authors.forename: Nick
authors.initials: N
authors.lastname: Sheron
mesh_terms: D000328:Adult; D017668:Age of Onset; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology*; D004651:Employment; D005260:Female; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D017533:Marital Status; D012931:Social Environment; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology