Clinical characteristics of alcoholism in alcohol-dependent subjects with and without a history of alcohol treatment

Background: Most clinical alcohol research is carried out on alcoholics who are in treatment, usually inpatients. However, most alcohol-dependent men and women never enter treatment, and even fewer ever receive inpatient care . Thus, some generally accepted data on the clinical course of alcoholism, derived from treatment samples, might not generalize to the entire populati on of alcohol-dependent individuals. This article characterizes the clinica l characteristics of alcohol dependence in three groups of alcoholics, base d on their histories of treatment for alcohol problems: those without prior rehabilitation; those with only outpatient approaches or Alcoholics Anonym ous (AA); and subjects with an inpatient experience. Methods: Semistructured interviews were administered to 3572 DSM-III-R-defi ned alcohol-dependent subjects from the Collaborative Study on the Genetics of Alcoholism. The clinical patterns were compared across the three groups of alcoholics: Group 1, never-treated (n = 1582; 44%); Group 2, histories of outpatient or AA only (n = 399; 11%); and Group 3, at least one inpatien t experience (n = 1591; 45%). Results: A progression was shown from Groups 1 to 3 for more general life p roblems (e.g., unemployment, marital instability); higher rates of addition al drug dependencies and psychiatric disorders; and more alcohol-related ad verse events. Logistic regression analyses revealed that those with no prio r treatment were more likely to be women, Caucasian, and employed, and to r eport a lower rate of divorce/separation, lower levels of alcohol intake, a nd fewer alcohol problems. Among those who received help, inpatient care wa s predicted by an opposite profile. Conclusions: These results indicate that studies using data from inpatient populations may give a skewed picture of the clinical characteristics of al cohol dependence.