Age of onset as a discriminator between alcoholic subtypes in a treatment-seeking outpatient population

Subtyping alcoholics may provide a more accurate guide as to the course and character of the disease. Classifications of different ages of onset of pr oblem drinking have so far resulted in categorical inconsistencies. In the past, hospital-based alcoholics have over-represented those most severely i ll, and comprehensive evaluations of psychopathology for discriminating bet ween alcoholic subtypes have been infrequent. In a heterogeneous treatment- seeking, outpatient, alcoholic-population, we tested the hypothesis that ag e of onset represents a continuum of disease, and that greater severity of psychopathology is associated with lower ages of onset. Using a standard questionnaire, 253 male and female treatment-seeking alcoh olics were stratified according to specific ages of onset: a) <20 years; b) 20-25 years, and c) >25 years. These age of onset groups were compared on alcohol severity and craving, family history, childhood behavior, personali ty, hostility, overt aggression, mood, and social functioning Symptom severity and age of onset were negatively correlated and the 20-25- year onset group usually bad intermediate scores. The <20 year onset group was characterized by greater severity of alcohol-related problems, family h istory, childhood behavioral problems, craving, hostility, antisocial trait s, mood disturbance, and poor social functioning. Alcoholics with an earlier ngo of onset have relatively greater psychopatho logy than those of later onset. While the preponderance of psychopathology among those in the <20-year onset group could be conceptualized as a clinic al "subtype," such a characterization would nor define an entirely homogeno us category. Yet, this clinical characterization would be clinically import ant if specific age of onset levels were found ro be differentially sensiti ve to pharmacological and/or psychological treatments.