CLINICAL RELEVANCE OF THE DISTINCTION BETWEEN ALCOHOL DEPENDENCE WITHAND WITHOUT A PHYSIOLOGICAL COMPONENT

Objective: DSM-IV indicates that diagnoses of substance dependence sho uld be further characterized with regard to the presence of a physiolo gical component, defined by tolerance or withdrawal. This study evalua ted the possible meaning of this distinction in alcohol-dependent men and women. Method: As part of the Collaborative Study on the Genetics of Alcoholism, structured interviews were carried out with 3,395 DSM-I II-R-defined alcohol-dependent individuals divided into 2,949 subjects (86.9%) with evidence of tolerance and/or withdrawal (group 1), 51.3% of whom evidenced withdrawal symptoms, and 446 subjects (13.1%) witho ut a physiological component (group 2!. Data were evaluated to determi ne differences between the two groups. Results: Group 1 reported great er severity of alcohol dependence as demonstrated by a larger maximum number of drinks in 24 hours, more persons reporting binges, more alco hol-related life problems, more relevant DSM-III-R criteria endorsed, more physiological complications, and more alcohol-related emotional/p sychiatric symptoms such as depression and anxiety. Each of these seve rity indicators for problems in group 1 was significant in the presenc e of the others in a logistic regression, and similar items remained s ignificant when tolerance alone, withdrawal alone, or their combinatio n was used as the criterion for group 1 membership; however, for withd rawal a larger proportion of the variance was explained by the predict or variables. The regression results were independent of gender, proba nd status, and history of antisocial personality disorder. Conclusions : The results support the clinical relevance of distinguishing between alcohol-dependent patients with and without a physiological component . The data indicate a potential advantage to limiting that definition to withdrawal only.