title: Clinical indices of familial alcohol use disorder.
abstract: BACKGROUND
  Alcohol use disorders (AUDs) are clinically heterogeneous and strongly influenced by familial/genetic factors. Can we identify specific clinical features of AUDs that index familial liability to illness?
  
  
  METHODS
  In twins from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders meeting DSM-IV criteria for lifetime AUDs, we examined whether clinical features of AUDs, including individual DSM-IV criteria for alcohol dependence (AD) and alcohol abuse (AA), predicted risk for AUDs in cotwins and/or parents. Analyses of individual criterion were repeated controlling for the total number of endorsed criteria.
  
  
  RESULTS
  Across these analyses, examining narrowly and broadly defined AUDs, risk of AUDs in relatives was more consistently predicted by abuse criteria than by dependence criteria, and by criteria reflecting negative psychosocial consequences rather than pharmacologic/biological criteria. Age at onset (AAO) poorly predicted risk in relatives. AUD associated legal problems, the one criterion slated for removal in DSM-5, was the most consistent single predictor of familial risk. Associations observed between individual criteria and risks of illness in relatives were generally stronger in monozygotic than dizygotic twin pairs, suggesting that these symptoms reflect a genetic risk for AUDs.
  
  
  CONCLUSIONS
  Individual DSM-IV criteria for AA and AD differ meaningfully in the degree to which they reflect the familial/genetic liability to AUDs. Contrary to expectation, the familial/genetic risk to AUDs was better reflected by symptoms of abuse and negative psychosocial consequences of AUD than by early AAO, or symptoms of tolerance and withdrawal.
authors.affiliation: Virginia Institute of Psychiatric and Behavioral Genetics , Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298-0126, USA. kendler@vcu.edu
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Kendler
authors.forename: John
authors.initials: J
authors.lastname: Myers
mesh_terms: D000328:Adult; D017668:Age of Onset; D000437:Alcoholism / Q000235:genetics* / Q000523:psychology; D004200:Diseases in Twins / Q000235:genetics / Q000523:psychology; D005190:Family; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010290:Parents; D012307:Risk Factors; D014429:Twins, Dizygotic / Q000235:genetics / Q000523:psychology; D014430:Twins, Monozygotic / Q000235:genetics / Q000523:psychology