Meta-analysis of DSM alcohol use disorder criteria severities: structural consistency is only 'skin deep'.

BACKGROUND: Item response theory (IRT) analyses of alcohol use disorder (AUD) and other psychological disorders are a predominant method for assessing overall and individual criterion severity for psychiatric diagnosis. However, no investigation has established the consistency of the relative criteria severities across different samples. METHOD: PubMed/Medline, PsycINFO, Web of Science and ProQuest databases were queried for entries relating to alcohol use and IRT. Study data were extracted using a standardized data entry sheet. Consistency of reported criteria severities across studies was analysed using generalizability theory to estimate generalized intraclass correlations (ICCs). RESULTS: A total of 451 citations were screened and 34 papers (30 unique samples) included in the research synthesis. The AUD criteria set exhibited low consistency in the ordering of criteria using both traditional [ICC = 0.16, 95% confidence interval (CI) 0.06-0.56] and generalized (ICC = 0.18, 95% CI 0.15-0.21) approaches. These results were partially accounted for by previously studied factors such as age and type of sample (e.g. clinical v. community), but the largest source of unreliability was the diagnostic instrument employed. CONCLUSIONS: Despite the robust finding of unidimensional structure of AUDs, inconsistency in the relative severities across studies suggests low replicability, challenging the generalizability of findings from any given study. Explicit modeling of well-studied factors like age and sample type is essential and increases the generalizability of findings. Moreover, while the development of structured diagnostic interviews is considered a landmark contribution toward improving psychiatric research, variability across instruments has not been fully appreciated and is substantial.

Towards the characterization and validation of alcohol use disorder subtypes: integrating consumption and symptom data.

BACKGROUND: There is evidence that measures of alcohol consumption, dependence and abuse are valid indicators of qualitatively different subtypes of alcohol involvement yet also fall along a continuum. The present study attempts to resolve the extent to which variations in alcohol involvement reflect a difference in kind versus a difference in degree. METHOD: Data were taken from the 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions. The sample (51% male; 72% white/non-Hispanic) included respondents reporting past 12-month drinking at both waves (wave 1: n = 33644; wave 2: n = 25186). We compared factor mixture models (FMMs), a hybrid of common factor analysis (FA) and latent class analysis (LCA), against FA and LCA models using past 12-month alcohol use disorder (AUD) criteria and five indicators of alcohol consumption reflecting frequency and heaviness of drinking. RESULTS: Model comparison revealed that the best-fitting model at wave 1 was a one-factor four-class FMM, with classes primarily varying across dependence and consumption indices. The model was replicated using wave 2 data, and validated against AUD and dependence diagnoses. Class stability from waves 1 to 2 was moderate, with greatest agreement for the infrequent drinking class. Within-class associations in the underlying latent factor also revealed modest agreement over time. CONCLUSIONS: There is evidence that alcohol involvement can be considered both categorical and continuous, with responses reduced to four patterns that quantitatively vary along a single dimension. Nosologists may consider hybrid approaches involving groups that vary in pattern of consumption and dependence symptomatology as well as variation of severity within group.

An integrative approach for studying the etiology of alcoholism and other addictions.

Studies of alcoholism etiology often focus on genetic or psychosocial approaches, but not both. Greater understanding of the etiology of alcohol, tobacco and other addictions will come from integration of these research traditions. A research approach is outlined to test three models for the etiology of addictions--behavioral undercontrol, pharmacologic vulnerability, negative affect regulation--addressing key questions including (i) mediators of genetic effects, (ii) genotype-environment correlation effects, (iii) genotype x environment interaction effects, (iv) the developmental unfolding of genetic and environmental effects, (v) subtyping including identification of distinct trajectories of substance involvement, (vi) identification of individual genes that contribute to risk, and (vii) the consequences of excessive use. By using coordinated research designs, including prospective assessment of adolescent twins and their siblings and parents; of adult substance dependent and control twins and their MZ and DZ cotwins, the spouses of these pairs, and their adolescent offspring; and of regular families; by selecting for gene-mapping approaches sibships screened for extreme concordance or discordance on quantitative indices of substance use; and by using experimental (drug challenge) as well as survey approaches, a number of key questions concerning addiction etiology can be addressed. We discuss complementary strengths and weaknesses of different sampling strategies, as well as methods to implement such an integrated approach illustrated for the study of alcoholism etiology. A coordinated program of twin and family studies will allow a comprehensive dissection of the interplay of genetic and environmental risk-factors in the etiology of alcoholism and other addictions.

Transitioning into and out of large-effect drinking in young adulthood.

As individuals age beyond the college years into young adulthood, many exhibit a tendency to moderate or "mature out of" alcohol involvement. The current study classified effect-drinking statuses in young adults and examined transitions among statuses using latent transition analysis, a latent variable state-sequential model for longitudinal data. At 3 occasions over 7 years (Years 1, 4, and 7), 443 men (47%) and women (mean age of both at baseline = 18.5 years; 51% with family history of alcoholism) responded to 3 past-30-day items assessing drinking and subjective effects of drinking: whether the respondent drank alcohol, felt high, and felt drunk. Latent statuses included abstainers (14% at Year 1), limited-effect drinkers (8%), moderate-effect drinkers (23%), and large-effect drinkers (54%). Respondents with family history of alcoholism were less likely to transition out of large-effect drinking than those without family history. Men exhibited more severe initial effect-drinking statuses and lower transition probabilities into less severe effect-drinking statuses than women.

Heavy drinking from the freshman year into early young adulthood: the roles of stress, tension-reduction drinking motives, gender and personality.

OBJECTIVE: This study investigated the relationship between stress (defined alternatively as negative life events and emotional distress) and heavy drinking across late adolescence and early young adulthood, as well as the roles of tension-reduction drinking motives and gender as moderators of that relationship. The role of personality variables (neuroticism, behavioral undercontrol and extraversion) as moderators also was explored. METHOD: The data were obtained from 485 individuals (255 women) participating in a five-wave longitudinal study that spanned 7 years. The effects on heavy drinking of stress (either negative life events or emotional distress), tension-reduction drinking motives, gender and personality were analyzed each year with hierarchical multiple regression. RESULTS: Stress (negative life events) was positively related to heavy drinking, but only for men with stronger tension-reduction drinking motives at Year 4 (age 21). The relationship between tension-reduction drinking motives and heavy drinking was positive, developmentally graded, and moderated by gender, after the freshman year, the role of tension-reduction drinking motives in heavy drinking became less important for women, relative to men, a trend that grew stronger after the college years. Behavioral undercontrol played a limited role in the relationship of gender and tension-reduction drinking motives to heavy drinking. CONCLUSIONS: The findings have implications for theories of stress-related and stress-motivated drinking. Such theories should consider developmental processes, particularly the transition to adult drinking status at age 21 and the roles of tension-reduction drinking motives, gender and behavioral undercontrol.

The problem of college drinking: insights from a developmental perspective.

This article represents the proceedings of a symposium at the 2000 RSA Meeting in Denver, Colorado. John Schulenberg and Jennifer L. Maggs were Organizers. Stephen W. Long was Chair and provided opening remarks. The presentations were: (1) I'm not a drunk, just a college student: Binge drinking during college as a developmental disturbance, by John Schulenberg; (2) Course of alcohol use disorders during college, by Kenneth J. Sher; (3) How do students experience alcohol and its effects? Positive versus negative expectancies and consequences, by Jennifer L. Maggs; and (4) Brief intervention in the context of developmental trends in college drinking, by G. Alan Marlatt. Critique and commentary were provided by Robert A. Zucker.

Short- and long-term effects of fraternity and sorority membership on heavy drinking: a social norms perspective.

This study sought to determine whether the well-established relation between fraternity/sorority (Greek) membership and heavy alcohol use persists beyond the college years and whether some common third variables might account for the relation between Greek status and heavy drinking. During each of 4 years of college and 1 additional year, young adults (N = 319) completed measures of alcohol use, personality, alcohol expectancies, and environmental influences on drinking. Throughout the college years, Greeks consistently drank more heavily than non-Greeks. Statistically controlling for previous alcohol use did not eliminate this effect. However, Greek status did not predict postcollege heavy drinking levels. Also, perceived peer norms for heavy drinking mediated the relation between Greek affiliation and heavy alcohol use. Results are discussed in terms of situational determinants of heavy alcohol involvement in young adults.

Clinical relevance of heavy drinking during the college years: cross-sectional and prospective perspectives.

This study investigated the clinical relevance of heavy drinking during the college years and beyond on concurrent and prospective alcohol-related problems in a high-risk sample (N = 377). Measures of heavy drinking and alcohol-related problems were significantly correlated cross-sectionally over the study frame, regardless of how these constructs were operationalized. However, the magnitude of the association between heavy drinking and alcohol-related problems declined substantially over time, with the most pronounced decrease following the college years. Despite this cross-sectional decrease in the association between heavy drinking and alcohol-related problems over time, heavy drinking during the college years significantly and substantially predicted alcohol-use disorders up to 10 years later. Implications for assessment of heavy drinking as well as prevention of problematic alcohol use in college students are discussed.

Risks of alcohol consumption in laboratory studies involving human research participants.

Research protocols that include alcohol consumption raise a number of critical issues with regard to potential risks to research participants, researchers, and institutions. This article seeks to highlight some of these issues by presenting some of the potential risks and discussing relevant dimensions and parameters of these risks. Risks to individual research participants are the primary focus of concern, but consideration of risks associated with aspects of the experimental, contextual, and institutional setting are also considered. The authors conclude with recommendations for individuals conducting studies involving alcohol consumption by human research participants.

Physiological alcohol dependence symptoms in early adulthood: a longitudinal perspective.

The developmental course of physiological dependence on alcohol was investigated by estimating the prevalance, stability, and prognostic significance of individual tolerance and withdrawal symptoms, prospectively over 7 years, in 450 young adults. Different prevalence rates and patterns of stability were observed with alternate tolerance items. Consistently low base rates were observed for all withdrawal items. Person-level stability of tolerance and withdrawal indicators was moderate at test-retest intervals of 1 year and increasingly modest at longer intervals. Reporting tolerance and withdrawal in early adulthood was associated with a substantial risk for later alcohol use disorder. Results suggest that the likelihood of experiencing tolerance or withdrawal symptoms may vary as a function of an individual's stage of development and drinking history. Implications for future assessment and classification of alcohol dependence are discussed.

Personality and substance use disorders: a prospective study.

The personality systems of Cloninger (as measured by the Tridimensional Personality Questionnaire [TPQ]) and Eysenck (as measured by the Eysenck Personality Questionnaire [EPQ]) both have been linked to substance use and abuse. The current study examined the predictive utility of both systems for substance use disorder (SUD) diagnoses, both cross-sectionally and prospectively. Participants (N = 489 at baseline) completed the EPQ and TPQ and were assessed via structured diagnostic interview at baseline and 6 years later (N = 457 at follow-up). Both the EPQ and TPQ scales demonstrated bivariate cross-sectional and prospective associations with SUDs. Within each system, those dimensions marking a broad impulsive sensation-seeking or behavioral disinhibition trait were the best predictors prospectively, although the 2 systems were differentially sensitive to specific diagnoses. These relations remained significant even with autoregressivity, other concurrent SUD diagnoses, and multiple personality dimensions statistically controlled.

Trajectories of concurrent substance use disorders: a developmental, typological approach to comorbidity.

BACKGROUND: Although alcohol and tobacco use disorders are highly comorbid, little is known regarding the combined course of these disorders. METHODS: The current study utilized latent class analysis to examine longitudinal patterns of alcohol-tobacco use disorder comorbidity. Participants were 449 young adults (baseline age, 18.5 years; 48% male; 51% with paternal history of alcoholism) assessed five times over 7 years. RESULTS: Five longitudinal types of alcohol or tobacco use disorder over time were identified: nondiagnosing; developmentally limited alcohol use disorder; chronic alcohol use disorder; chronic tobacco use disorder; and comorbid alcohol and tobacco use disorder. These typologies were distinguishable on the basis of family history of alcoholism status and sex. Etiologically important third variables (alcohol expectancies, behavioral undercontrol, childhood stressors) mediated the relation between family history and the latent classes. CONCLUSIONS: Characterizations of alcohol use disorders typically fail to consider important sources of heterogeneity such as course or comorbidity. By simultaneously modeling developmental course and comorbidity with tobacco dependence, we were able to identify distinct trajectories of single and concurrent substance use disorders. Such multi-substance trajectories represent meaningful subtypes that, although sharing substantial common influences, have unique etiologic correlates. Additionally, these subtypes might represent distinct groups from the perspective of intervention strategies.

Collegiate alcohol involvement and role attainment in early adulthood: findings from a prospective high-risk study.

OBJECTIVE: Recent research has highlighted the magnitude of alcohol use and alcohol-related problems on college campuses. However, the effects of alcohol use and abuse during the college years on early adult role attainment are not well characterized. Accordingly, this study was designed to prospectively examine relations between alcohol involvement during the college years and early adult educational and occupational attainment. METHOD: Participants (N = 429: 231 women) at low and high risk for the development of alcoholism were recruited at a large midwestern university for a study of alcohol and health during the college years. Alcohol involvement was assessed by self-report and structured clinical interviews conducted annually for 4 years. Educational and occupational attainment were assessed by self-report 6 years postmatriculation. RESULTS: Alcohol involvement demonstrated a modest prospective effect on educational attainment, with a reduced effect observed when analyses controlled for academic aptitude and high school academic achievement. Prior academic achievement moderated the relation between alcohol involvement and educational attainment, such that individuals who were higher on secondary school class ranking were more negatively affected by pathologic alcohol involvement than those with lower levels of prior academic achievement. Less consistent evidence was found for prospective relations between alcohol involvement and early adult occupational attainment. CONCLUSIONS: These findings indicate a modest role for alcohol involvement in negative educational outcomes, with a more pronounced negative effect of alcohol involvement on educational attainment among those who were high academic performers in high school.

Borderline personality disorder and substance use disorders: a review and integration.

The empirical literature on the comorbidity between borderline personality disorder (BPD) and substance use disorders (SUDs) is reviewed. BPD-SUD comorbidity data obtained from studies published from 1987 to 1997 document the frequent co-occurrence of these diagnoses. Methodological issues and theoretical models for understanding this co-occurrence are discussed. Finally, we present our conceptualization of the relations and interactions of the major factors influencing the development of BPD and contributing to the comorbidity between BPD and SUDs.

Distinguishing manifestations of anxiety: how do personality traits of compulsive checkers differ from other anxious individuals?

To better understand relations between personality and anxiety in general, and personality differences between compulsive checkers and nonchecking anxious individuals in particular, the current study was conducted. Participants included a nonclinical undergraduate sample of 36 compulsive checkers, 33 nonchecking anxious controls and 33 nonchecking nonanxious controls who were compared on five basic personality dimensions: emotional stability, extraversion, agreeableness, conscientiousness and intellect (Goldberg, 1992). Results indicated that a combined group of all anxious individuals was less extraverted and less emotionally stable than nonchecking/nonanxious controls. Results further indicated that compulsive checkers were less emotionally stable and more conscientious than nonchecking anxious controls. The implications of these findings, as well as the impact of the order of personality item presentation, are considered and discussed.

Prospective analysis of comorbidity: tobacco and alcohol use disorders.

Alcohol use disorders (AUD) and tobacco use disorders (TD) frequently co-occur. The authors examined AUD-TD comorbidity over time using a state-trait (ST) model. The ST model represents variance in AUD/TD as a traitlike factor that spans measurement occasion and identifies distinct sources of variance in AUD-TD comorbidity. The ST model was evaluated on 450 young adults (baseline age = 18.5 years; 51% with family history of alcoholism) assessed 5 times over 7 years. The ST model demonstrated superior fit over a first-order autoregressive model. The tendency to diagnose with AUD and TD was partially explained by family history of alcoholism; this relationship was mediated by childhood stressors, alcohol expectancies, and behavioral undercontrol. Results supported a common third-variable influence (vs. directional) model of comorbidity. The ST model is an important conceptual and methodological approach to the prospective study of comorbidity in general.

Prospective analysis of the relation between DSM-III anxiety disorders and alcohol use disorders.

OBJECTIVE: Cross-sectional studies show a robust association between anxiety disorders and alcohol use disorders (comorbidity); however, this methodology does not allow for the testing of causal models. The authors attempted to overcome this limitation by examining comorbid relationships prospectively. METHOD: Male and female college students were assessed as freshmen (year 1), and then again at years 4 and 7, for selected 12-month anxiety disorders (generalized anxiety disorder, agoraphobia, and social phobia or panic) diagnosed according to the National Institute of Mental Health Diagnostic Interview Schedule (DIS) and DSM-III and for 12-month DIS/DSM-III alcohol use disorders (alcohol dependence alone and alcohol abuse or dependence). RESULTS: Cross-sectionally, the odds of having either an anxiety disorder or an alcohol use disorder were two- to fivefold greater when the other condition was present. Prospectively, the odds of developing a new alcohol dependence diagnosis at year 7 increased from 3.5 to five times for those diagnosed with an anxiety disorder at years 1 or 4. Conversely, the odds of developing a new anxiety disorder at year 7 increased by about four times for those diagnosed with alcohol dependence at years 1 or 4. When alcohol abuse and dependence were combined, the pattern of findings was similar, albeit weaker. Multivariate path models provide similar results and highlight the reciprocal influence of alcohol use disorders and anxiety disorders. CONCLUSIONS: Alcohol use disorders (especially alcohol dependence) and anxiety disorders demonstrate a reciprocal causal relationship over time, with anxiety disorders leading to alcohol dependence and vice versa.

Pathological alcohol involvement: a developmental disorder of young adulthood.

In 1987, we began a longitudinal study of the offspring of alcoholic parents and have been following this group of young adults from their freshman year in college throughout their transition into later young adulthood. The goal of this review is to highlight some of the findings we consider most important and relevant to the development of pathological alcohol involvement in young adulthood. Courses of pathological alcohol involvement in young adulthood are outlined. Predictors of both the development and course of pathological alcohol use in young adulthood are also addressed, including family history of alcoholism, personality, alcohol use motivations, and role transitions. While certainly a problem in its own right, pathological alcohol involvement can also affect the attainment of important life tasks and success in various life roles. Consequently, we also examine the effects of pathological alcohol involvement on later role transitions and role attainment. Finally, prevention, policy, and treatment issues surrounding this stage of life are discussed.

The relation between personality and anxiety: findings from a 3-year prospective study.

The authors tested the extent to which the personality dimensions of neuroticism, extraversion, and psychoticism (H. J. Eysenck & S. B. G. Eysenck, 1975) prospectively predicted global anxiety (assessed by items from the Brief Symptom Inventory: L. R. Derogatis & M. S. Spencer, 1982). The authors also examined prospective relations among these personality dimensions and depression to evaluate the specificity of findings. Participants were 466 young adults, primarily undergraduate students, assessed twice over a 3-year interval. An interaction between neuroticism and extraversion predicted both global anxiety and depression 3 years later. Findings indicated that personality, in particular the combination of high neuroticism and low extraversion, may play an important predisposing, etiological role in anxiety. Interpretations and implications of the predictive importance of the Neuroticism x Extraversion interaction in anxiety are discussed, and further speculations about the relation between anxiety and depression are put forth.