Five-year clinical course associated with DSM-IV alcohol abuse or dependence in a large group of men and women.

OBJECTIVE: The prognostic validity of the DSM-IV diagnoses of alcohol abuse and alcohol dependence was evaluated by examining the 5-year clinical course associated with those diagnoses in a large group of predominantly blue-collar men and women. METHOD: Personal semistructured interviews were carried out 5 years after an initial evaluation with 1,346 (75%) of the approximately 1,800 men and women participating in the Collaborative Study on the Genetics of Alcoholism who were eligible for follow-up. RESULTS: About two-thirds of the 298 subjects with DSM-IV alcohol dependence at baseline maintained that diagnosis during the 5-year study period. Fifty-five percent of the 288 subjects with DSM-IV alcohol abuse at baseline continued to meet one or more of the 11 DSM-IV abuse/dependence criteria, and 3.5% went on to meet the criteria for dependence at follow-up. Among the 760 subjects with no alcohol diagnosis at baseline, 2.5% met the criteria for alcohol dependence and 12.8% for alcohol abuse at follow-up. Baseline characteristics that predicted the occurrence of any of the 11 DSM-IV abuse/dependence criteria during the 5-year interval included male gender, lack of marital stability, presence of several of the criteria for dependence, and history of illicit drug use. CONCLUSIONS: The data suggest that over 5 years the DSM-IV diagnosis of alcohol dependence predicts a chronic disorder with a relatively severe course, while DSM-IV alcohol abuse predicts a less persistent, milder disorder that does not usually progress to dependence.

Clinical implications for four drugs of the DSM-IV distinction between substance dependence with and without a physiological component.

OBJECTIVE: The DSM-IV work group asked researchers and clinicians to subtype substance dependent individuals according to the presence or absence of physiological symptoms. A recent report from the Collaborative Study on the Genetics of Alcoholism demonstrated that among alcohol-dependent men and women, a history of tolerance or withdrawal was associated with a more severe clinical course, especially for individuals with histories of alcohol withdrawal. This article evaluates similar distinctions among subjects in the collaborative study who were dependent on marijuana, cocaine, amphetamines, or opiates. METHOD: Structured interviews gathered information from 1,457 individuals with a lifetime diagnosis of marijuana dependence, 1,262 with histories of cocaine dependence, 647 with amphetamine dependence, and 368 subjects with opiate dependence. For each drug, the clinical course was compared for subjects whose dependence included a history of withdrawal (group 1), those dependent on each drug who denied withdrawal but reported tolerance (group 2), and those who denied both tolerance and withdrawal (group 3). RESULTS: The proportion of dependent individuals who denied tolerance or withdrawal (group 3) ranged from 30% for marijuana to 4% for opiates. For each substance, individuals in groups 1 and 2 evidenced more severe substance-related problems and at least a trend for greater intensities of exposure to the drug; those reporting withdrawal (group 1) showed the greatest intensity of problems. CONCLUSIONS: The designation of dependence in the context of tolerance or withdrawal identifies individuals with more severe clinical histories. These results support the importance of the designation of a physiological component to dependence, especially for people who have experienced a withdrawal syndrome.

Mood and anxiety symptoms among 140 children from alcoholic and control families.

OBJECTIVE: Children of alcoholics have been reported to have elevated levels of internalizing symptoms, including anxiety and depression. However, many studies have not adequately controlled for the influence of independent (i.e. not substance-induced) parental mood or anxiety disorders and other factors. The present evaluations assess the relationships of the family histories of alcohol use disorders and independent mood and anxiety disorders to internalizing symptoms in children of alcoholic and nonalcoholic subjects. METHOD: A behavioral checklist and a structured interview were administered to the parents of 140 children aged 7-18 years. The fathers of these offspring had been recruited 15 years previously from a university population to participate in a prospective study of 453 men from alcoholic and nonalcoholic families. RESULTS: While a higher score for one of four measures of internalizing symptoms in the children was found to relate to a higher density of alcoholic relatives, this pattern was more robust in children of parents with mood or anxiety disorders. In a hierarchical regression, the family history of alcohol use disorders did not add significantly to the prediction of any of the four internalizing scores in the children after considering the impact of a family history of independent mood and anxiety disorders. CONCLUSIONS: The results indicate that internalizing symptoms in children of alcoholics were more strongly influenced by a positive family history of mood and anxiety disorders than the family history of alcohol use disorders.

Cardiovascular responses of Oriental and Caucasian men to alcohol: some psychological correlates.

After drinking a small dose of alcohol, Orientals flushed, their heart rates increased and their diastolic pressures decreased; Caucasians' skin reflectance did not change, but their heart rates and systolic blood pressures decreased. In both groups, flushing was associated with an increase in feelings of vigor. Other mood correlates depended on condition.

Alcohol consumption and use norms among Chinese Americans and Korean Americans.

Homeland (Taiwan) Chinese are very low in alcohol consumption, while homeland Koreans are very high in alcohol consumption. Neither Chinese Americans nor Korean Americans constitute a large portion of the residents of Hawaii, but across four surveys, data were obtained from 212 Chinese-American and 72 Korean-American college students or students' parents. Persons from these groups do not differ greatly. Korean Americans are slightly higher in reported alcohol use and in judgments of the nature of normal alcohol use. The two groups do not differ in their judgments of the nature of problem alcohol use.

Clinical characteristics and family histories of alcoholics with stimulant dependence.

OBJECTIVE: While much is known about the clinical patterns and family histories of individuals with alcoholism or stimulant (cocaine and amphetamine) dependence, there are few data that describe men and women with concomitant alcohol and stimulant dependence. METHOD: As part of the Collaborative Study on the Genetics of Alcoholism, structured interviews were administered to 3,882 (2,432 male) DSM-III-R defined alcohol and/or stimulant dependent subjects. The characteristics and family histories of four groups were compared: Group 1 (26%), with the onset of alcohol before stimulant dependence; Group 2 (10%), with alcohol dependence simultaneously with or after stimulant dependence; Group 3 (58%), with alcohol dependence only; Group 4 (6%), with stimulant dependence only. RESULTS: Individuals with concomitant alcohol and stimulant dependence (Groups 1 and 2) reported more general life problems (e.g., marital instability), a higher rate of antisocial personality disorder and more substance-induced mood disorders, additional drug dependencies and substance-related difficulties than those with dependence on one substance only. People with alcohol dependence before stimulant dependence had the most severe clinical patterns. In addition, alcohol dependence and stimulant dependence were found to breed true in families of subjects with these concomitant disorders. The major findings were confirmed with logistic regression analyses, and were independent of ASPD and gender. CONCLUSIONS: It is important for clinicians to be aware of the severe clinical characteristics of patients with concomitant alcohol and stimulant dependence. In addition, the data consistent with drug-specific heritability in this heterogeneous population may be useful to researchers.

A preliminary evaluation of the potential usefulness of the diagnoses of polysubstance dependence.

OBJECTIVE: The concept of polysubstance dependence (PD) has been defined several ways over the years. However, few clinicians and researchers appear to use this label in a manner consistent with any of the major diagnostic manuals. This article evaluates the prevalence and characteristics associated with PD in participants in a large collaborative study. METHOD: In DSM-IV, PD characterizes people who do not meet criteria for dependence on any one substance but, when all drugs of abuse are considered have experienced three or more of the seven dependence items across the substances. In this study, structured face-to-face interviews were administered to 8,834 men and women as part of the Collaborative Study on the Genetics of Alcoholism. The 198 subjects (2.2%) with a slightly expanded concept of the DSM-IV disorder were compared with men and women with dependence on alcohol, marijuana or stimulants, subjects with substance abuse and those with no substance use disorder. RESULTS: In this dataset, compared with subjects with a specific substance dependence, those with PD were slightly more educated and less likely to be divorced or separated, and they had fewer substance-related problems. At the same time, those with PD had more substance problems than did subjects who only met criteria for abuse. These basic conclusions were unchanged among the subset of 59 subjects who met the more restricted, classical DSM-IV PD criteria. CONCLUSIONS: The data indicate that, while relatively rare, subjects with PD might differ in potentially important ways from those with dependence or abuse on specific drugs. A large prospective study of a group with carefully defined PD is needed.

Group similarities in beliefs concerning the causes of alcohol problems and the effectiveness of means of overcoming problem alcohol use.

Four hundred and eight respondents, who did or did not know persons close to themselves with alcohol problems, from four different racial/ethnic groups (with one group, Filipinos, categorized in terms of whether they were born in the Philippines or in the U.S.) rated the importance of 19 different causes of problem alcohol use and 22 different means of overcoming problem alcohol use. Rank-order correlations across sexes, persons differing in exposure to problem drinkers, and ethnic groups were nearly all in the 0.90's regarding causation. Correlations of Caucasians' ratings with those of other groups were high, but only in the 0.60's and 0.70's, chiefly because Caucasians were more prone to regard problem alcohol use as hereditary and as a disease, and less likely to believe problem use to result from social factors. All across-group correlations concerning beliefs about the effectiveness of means of overcoming problems were in the 0.90's. Some of the means of treatment regarded most highly by all groups have not been demonstrated to be effective.

Assisted suicide and AIDS patients. A survey of physicians' attitudes.

Physicians' attitudes about assisted suicide were assessed by using a vignette of an acquired immune deficiency syndrome (AIDS) patients who requests a lethal injection. Of the 389 respondents, 34% received at least 1 request for assisted suicide; 9% had requests from an AIDS patient; and 41% had at least indirectly assisted a terminal patient to die in actual practice. Thirty-three percent of the respondents agreed to the authors' hypothetical patient's request for a lethal injection. Medical and personal experiences did not determine attitudes that were somewhat influenced by ethical beliefs and religious commitment. The study confirms previous findings that many physicians underestimate the effect of depressive illness on rational decision making concerning assisted suicide the effect of depressive illness on rational decision making concerning assisted suicide requests.

Assortative mating for cultural identification as indicated by language use.

Persons of Japanese ancestry from Hawaii who marry within their own racial/ethnic group show a significant degree of homogamous assortative mating for "pidgin" and for standard English usage, variables reflective of important cultural differences in Hawaii. Persons of Japanese ancestry who married persons of other racial/ethnic groups had less exposure to pidgin in their parental homes and were less likely to speak this dialect of English. Sibling-spouse analyses suggested that assortment for such language use is entirely due to social homogamy rather than active phenotypic assortment.

Intergroup similarities in judgements of psychiatric symptom severity.

Researchers have stated that racial/ethnic groups, even if residing in the same locale, differ substantially in their judgments of the severity of psychiatric symptoms. Severity was defined as the degree to which a symptom would lead to the belief that the person manifesting the symptom had some form of mental disturbance or psychological problem needing treatment. Research participants residing in Hawaii's, varying in sex, age, educational level, and ethnicity, rated the severity of 49 psychiatric symptoms. All groups were in close agreement with one another in their severity ratings, suggesting that group differences in beliefs may be far less than had been claimed.

A 5-year prospective evaluation of DSM-IV alcohol dependence with and without a physiological component.

BACKGROUND: The DSM-III-R removed tolerance and withdrawal as required elements for a diagnosis of alcohol dependence. Although this practice was continued in DSM-IV, the more recent manual asked clinicians to note whether physiological aspects of withdrawal (tolerance and withdrawal) had ever been experienced. Few studies have determined the prognostic meaning of a history of a physiological component to DSM-IV alcohol dependence. METHODS: Face-to-face structured interviews were used to evaluate the course of alcohol, drug, and psychiatric problems during the subsequent 5 years for 1094 alcohol-dependent men and women. These subjects had been classified into subgroups at the time of initial interview regarding evidence of tolerance or withdrawal, and all evaluations were based on DSM-IV criteria. At baseline, the application of DSM-IV diagnostic guidelines resulted in 649 (59.3%) individuals having a history of an alcohol withdrawal syndrome, with or without tolerance (group 1); 391 (35.7%) with histories of tolerance but not withdrawal (group 2); and 54 (4.9%) with no lifetime histories of tolerance or withdrawal (group 3). RESULTS: During the 5-year follow-up, both the broad (group 1 plus 2 versus group 3) and narrow (group 1 versus group 2 plus group 3) definitions of physiological dependence were associated with more alcohol and drug problems. However, for most items, this differential primarily reflected differences between groups 1 and 3, with a less impressive effect by group 2. Although no group differences were noted for the rate of independent major depressive episodes, substance-induced depressions did differentiate among groups, a finding also most closely related to the distinction between groups 1 and 3. CONCLUSIONS: These data support the prognostic importance of noting the presence of a physiological component in alcohol dependence and indicate the potential relevance of limiting the definition of a physiological component to withdrawal.

Religious affiliation, religious involvement, and alcohol use in Korea.

This article is the first study of religious commitment and involvement of homeland Koreans as related to alcohol use. Religious affiliation and involvement are predictive of abstemiousness, but chiefly for women, who are at low risk for alcohol abuse and dependency, and not for men, who are at high risk. The frequent abstemiousness of Buddhist women results chiefly from data having to do with mothers and probably is a consequence of the women's traditional lifestyles, being both Buddhist and abstemious. Among the probably more Westernized Christians, religious involvement is most clearly associated with abstemiousness among daughters, a group at a relatively low but increasing risk for alcohol use.

Factor structure of the CES-D (Center for Epidemiologic Studies Depression Scale) among Filipino-American adolescents.

The present study used factor analytic procedures to examine the factor structure of the CES-D among Filipino-American adolescents residing in rural and small town Hawaii. A total of 243 Filipino-American high school students completed the 20-item scale, and maximum likelihood analyses were employed to obtain a final solution. The results indicated that two factors provide a reasonably good fit: factor I combined depressed affect, somatic-retardation and interpersonal items, and factor II consisted of the remaining four positive affect items. The overlap of depressed affect and somatic symptoms support previous findings found among Asian American adults and other ethnic minority adolescents. The loading of the interpersonal items on the first factor is more unusual and suggests that interpersonal factors are not distinguished from depressed affect for the Filipino-American adolescent group. The usefulness of the CES-D as a tool to gain an understanding of the concept of depression across cultures is discussed.

Clinical characteristics of alcoholism in alcohol-dependent subjects with and without a history of alcohol treatment.

BACKGROUND: Most clinical alcohol research is carried out on alcoholics who are in treatment, usually inpatients. However, most alcohol-dependent men and women never enter treatment, and even fewer ever receive inpatient care. Thus, some generally accepted data on the clinical course of alcoholism, derived from treatment samples, might not generalize to the entire population of alcohol-dependent individuals. This article characterizes the clinical characteristics of alcohol dependence in three groups of alcoholics, based on their histories of treatment for alcohol problems: those without prior rehabilitation; those with only outpatient approaches or Alcoholics Anonymous (AA); and subjects with an inpatient experience. METHODS: Semistructured interviews were administered to 3572 DSM-III-R-defined alcohol-dependent subjects from the Collaborative Study on the Genetics of Alcoholism. The clinical patterns were compared across the three groups of alcoholics: Group 1, never-treated (n = 1582; 44%); Group 2, histories of outpatient or AA only (n = 399; 11%); and Group 3, at least one inpatient experience (n = 1591; 45%). RESULTS: A progression was shown from Groups 1 to 3 for more general life problems (e.g., unemployment, marital instability); higher rates of additional drug dependencies and psychiatric disorders; and more alcohol-related adverse events. Logistic regression analyses revealed that those with no prior treatment were more likely to be women, Caucasian, and employed, and to report a lower rate of divorce/separation, lower levels of alcohol intake, and fewer alcohol problems. Among those who received help, inpatient care was predicted by an opposite profile. CONCLUSIONS: These results indicate that studies using data from inpatient populations may give a skewed picture of the clinical characteristics of alcohol dependence.

Judgments of "normal" and "problem" alcohol use as related to reported alcohol consumption.

We obtained alcohol use data and judgments of individual ("What do you think?") and cultural ("What do people in general think?") norms for normal and problem quantity and frequency of alcohol use, as well as ratings of whether particular alcohol-related behaviors indicated a drinking problem, from 928 adult respondents who were members of Hawaii's five major racial/ethnic groups [Chinese, European (Caucasian), Filipino, Hawaiian/Part-Hawaiian, and Japanese ancestry]. As compared with older survey data (but consonant with recent survey data), Hawaiians have substantially increased in alcohol use, as have Filipinos (if they drink at all; a high proportion are abstainers), and to a lesser extent, Japanese. Chinese remain very low in alcohol use, while Caucasians have relatively decreased in use. Alcohol use norms (especially of own judged normal use) vary across sexes and ethnic groups and are predictors of consumption both within and across groups. Family resemblances are substantial with regard to alcohol use category (present users, former drinkers, abstainers). Among present users, family resemblances are often significant with regard to amount used; resemblances are more substantial between mothers and offspring than between spouses or between fathers and offspring. There were small but significant ethnic group differences in the number of specific behaviors judged to be indicative of a drinking problem, with the groups reporting the highest mean alcohol consumption (Caucasians and Hawaiians/Part Hawaiians) also indicating more behaviors, particularly pathological as opposed to celebratory behaviors, as being problematic.(ABSTRACT TRUNCATED AT 250 WORDS)

Familial transmission of alcohol use norms and expectancies and reported alcohol use.

Members of 183 families (biological parents and one adult offspring) completed questionnaires on their quantity and frequency of alcohol use, what they would consider a "normal" quantity-frequency of alcohol use, "problem" quantity-frequency of use, flushing after alcohol use, and other expected physiological and subjective responses to alcohol. Within individuals, own quantity-frequency of alcohol use was moderately negatively correlated with flushing after one drink or less ("fast flushing"), but more highly positively correlated with judged normal alcohol use and with expected subjective effects. Spouse resemblances were low for quantity-frequency of alcohol use and flushing, but high for alcohol use norms and expected physiological and subjective responses. Parent-offspring resemblances were low to moderate for own alcohol use and flushing, but moderate to high for expected physiological and subjective effects. These results were discussed in terms of the effects of genetically transmitted flushing after alcohol use and culturally transmitted alcohol norms and expectations on alcohol use.

Clinical correlates of cigarette smoking and nicotine dependence in alcohol-dependent men and women. The Collaborative Study Group on the Genetics of Alcoholism.

This paper examines the clinical characteristics associated with tobacco use and nicotine dependence in a large sample of alcohol-dependent subjects. The goal was to determine if the characteristics of the alcohol use history were associated with the smoking status, even after controlling for additional characteristics, such as the antisocial personality disorder, other drug dependence and gender. As part of the Collaborative Study on the Genetics of Alcoholism, a semi-structured interview, including a detailed history of alcohol and tobacco use, was administered to 1005 alcohol-dependent men and women, made up of 658 (65.5%) current smokers, 167 (16.6%) former smokers, and 180 (17.9%) non-smokers. Among former smokers, 50.3%, and among current smokers, 72.8% had ever been nicotine-dependent (DSM-III-R). Current smokers and nicotine-dependent subjects had a greater severity of alcohol dependence, even as evaluated through logistic regression analyses in which gender and associated diagnoses were considered. The data also enabled us to study the relationships among depression, nicotine dependence, and alcohol dependence, with most of the correlation occurring for substance-induced, not independent, mood disorders.

Depressive symptoms among Filipino American adolescents.

Minority ethnic status has been found to be related to higher levels of depressive symptoms among adolescents and adults. The present study examined the rates of depressive symptoms (as measured by the Center for Epidemiologic Studies Depression Scale: CES-D Scale) of 270 Filipino American adolescents residing in rural and small-town areas of Hawaii. CES-D scores were compared with scores of a White group, and no ethnic differences were found. Compared with Filipino males, Filipino females were found to have higher CES-D scores, with higher mean scores on the majority of the CES-D items. The few Filipino students who reported attempting suicide had moderately high to very high levels of reported depressive symptoms. Lack of ethnic differences may be due to Hawaii's unique cultural mix, where there is no single "majority group" and a high rate of cultural interaction.