PHYSIOLOGICAL ALCOHOL DEPENDENCE AS A SPECIFIER OF RISK FOR MEDICAL PROBLEMS AND RELAPSE LIABILITY IN DSM-IV

Objective: This study tested the ability of DSM-TV physiological alcoh ol dependence to predict multiple indices of medical problems and rela pse behavior. It also tested the ability of three additional variables -DSM-IV nonphysiological dependence, an alternative dichotomous criter ion for coding physiological dependence and a dimensional measure of p hysiological dependence-to predict medical problems and relapse behavi or in alcoholism. Method: A heterogeneous group of 365 patients was re cruited from eight addictions treatment programs in the northeastern U nited States. A multidimensional assessment battery able to diagnose t he presence of physiological dependence according to each of three sys tems-the criteria of DSM-IV, alternative dichotomous criteria and a di mensional scale-was administered about 2 weeks after admission, and 24 1 subjects were reinterviewed 6 months later. The three systems were c ompared for their ability to predict a variety of external measures of medical complications and relapse liability. Results: Physiological a lcohol dependence as diagnosed by DSM-IV bore no relationship to eithe r risk for medical problems or relapse behavior. Further analyses show ed that this failure was due to operational problems of physiological dependence in DSM-IV, rather than to a lack of conceptual merit for ph ysiological dependence per se as a course specifier. Use of alternativ e criteria for coding physiological dependence which are difficult and less internally consistent, and use of a dimensional measure, found i mproved relationships with the external validators. Conclusions: Contr ary to early reports, physiological dependence can serve as a course s pecifier for alcohol problems, but must be more sensitively scaled tha n it was in DSM-IV. Tests of alternative options suggest that a multis tage criterion to replace DSM-IV's dichotomous criterion is the best r emedy.