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

Published online by Cambridge University Press:  03 April 2013

K. M. Jackson ,
K. K. Bucholz ,
P. K. Wood ,
D. Steinley ,
J. D. Grant  and
K. J. Sher
K. M. Jackson*
Affiliation:
Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
K. K. Bucholz
Affiliation:
Washington University School of Medicine in St Louis, St Louis, MO, USA Midwest Alcoholism Research Center
P. K. Wood
Affiliation:
Midwest Alcoholism Research Center University of Missouri-Columbia, Columbia, MO, USA
D. Steinley
Affiliation:
Midwest Alcoholism Research Center University of Missouri-Columbia, Columbia, MO, USA
J. D. Grant
Affiliation:
Washington University School of Medicine in St Louis, St Louis, MO, USA Midwest Alcoholism Research Center
K. J. Sher
Affiliation:
Midwest Alcoholism Research Center University of Missouri-Columbia, Columbia, MO, USA
*
*Address for correspondence: K. M. Jackson, Ph.D., Brown University, Center for Alcohol and Addiction Studies, Box G-S121-4, Providence, RI 02912, USA. (Email: kristina_jackson@brown.edu)
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Abstract

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.

Keywords

Alcoholcategoricalconsumptiondependencetypology
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 1 , January 2014 , pp. 143 - 159
Copyright
Copyright © Cambridge University Press 2013 

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