Drinking course in alcohol-dependent men from adolescence to midlife

Objective: Most studies of alcoholism course are based on clinical populations (characterized by severe and chronic alcohol-related problems) or community samples generally covering a short period of time. The current study assessed variations in drinking behaviors from adolescence to midlife in a community sample, describing age of "drinking firsts" (e.g., first alcoholic drink) as well as frequency and duration of periods of abstinence, alcohol dependence (AD) and nonproblem drinking. Method: Participants were 354 males with lifetime diagnoses of AD (mean age 50.35) from the Vietnam Era Twin Registry who were assessed regarding alcohol use, abuse and dependence histories (DSM-IV). Using a modified version of Skinner's Lifetime Drinking History, drinking history was reported in terms of distinct drinking periods (phases). Results: Participants reported, on average, 4.18 phases, each lasting 8.22 years, and 12.78 years of AD. More than 60% experienced increases in AD symptoms at least once in successive phases, but only a third of those increases were extreme. In contrast, extreme decreases in AD symptoms were reported by more than 50% of participants. Further, half indicated that they had transitioned from both fewer to greater and from greater to fewer AD symptoms during their drinking years; 8.2% reported no changes in AD symptoms. Conclusions: Results reflect a wide variation in drinking behaviors among AD men as well as frequent fluctuations in course within individuals' drinking histories. Findings do not support a universal developmental model of alcoholism; notably, they provide counterevidence to the disease model concept of alcoholism course as progressive and chronic.