Edwards' concept of the alcohol dependence syndrome (ADS) has served as the stimulus for much alcohol research and has provided the basis for the definitions of alcohol dependence in DSM-III-R, ICD-10, and proposed DSM- IV criteria. Despite the fact that these definitions have a substantial influence on the field of alcohol research, including epidemiology, little is known about their concordance or their differential short-term and long-term validity in general population samples, or in women in any setting. The proposed study is designed to continue the research already begun to provide information on these issues. A sample of 969 household residents (46% female) has been recruited who reported at least one recent occasion of at least moderately heavy drinking. They all participated in a detailed survey interview covering alcohol consumption, alcohol use disorders and potentially related experiences. Clinician semi-structured reappraisal of these subjects has been conducted with 792 of the subjects. This reappraisal covers alcohol, drug and psychiatric disorders, using a highly reliable instrument developed for this and similar samples. One- year follow-up interviews are currently underway for the entire sample, and on-time completion of the follow-up interviews remains at about 90%. In the first interview, approximately 25% of the sample reported current alcohol dependence (last 12 months), 45% reported past alcohol dependence (prior to the last 12 months), with a total of approximately 50% reporting lifetime alcohol dependence. Most cases of alcohol dependence were at the mild to moderate level. Preliminary follow-up results indicate considerable movement into and out of dependence, with many additional subjects manifesting subclinical levels of dependence symptoms. Funds are sought to analyze this complex and rich general population data set to accomplish the following aims: (1) to determine the concordance of DSM- III, DSM-III-R, DSM-IV and ICD-10 diagnoses of alcohol use disorders, (2) to investigate the dimensionality of alcohol abuse and dependence criteria through exploratory and confirmatory factor analyses, (3) to develop and test reliability of severity measures of dependence based on the diagnostic criteria, (4) to analyze the concordance between survey and clinician assessment of alcohol dependence, (5) to evaluate the cross- sectional validity of definitions of alcohol dependence by testing their association with a set of theoretically predicted correlates, and (6) to evaluate the predictive validity of definitions of alcohol dependence by testing predictions concerning short-term (one-year) outcome. Long-range aims continue to include achieving a better understanding of the validity of definitions of alcohol dependence and also of the effect of psychiatric, psychosocial and other predictors of the onset and offset of alcohol use disorders.
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