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

Marc A. Schuckit, G. P. Danko, T. L. Smith, V. Hesselbrock, J. Kramer, K. Bucholz

Research output: Contribution to journalReview articlepeer-review

38 Scopus citations


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.

Original languageEnglish
Pages (from-to)818-825
Number of pages8
JournalAlcoholism: Clinical and Experimental Research
Issue number5
StatePublished - May 1 2003


  • Alcoholism
  • Diagnosis
  • Tolerance
  • Withdrawal


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