Five-year clinical course associated with DSM-IV alcohol abuse or dependence in a large group of men and women

Objective: The prognostic validity of the DSM-IV diagnoses of alcohol abuse and alcohol dependence was evaluated by examining the 5-year clinical cour se associated with those diagnoses in a large group of predominantly blue-c ollar men and women. Method: Personal semistructured interviews were carried out 5 years after a n initial evaluation with 1,346 (75%) of the approximately 1,800 men and wo men participating in the Collaborative Study on the Genetics of Alcoholism who were eligible for follow-up. Results: About two-thirds of the 298 subjects with DSM-IV alcohol dependenc e at baseline maintained that diagnosis during the 5-year study period. Fif ty-five percent of the 288 subjects with DSM-IV alcohol abuse at baseline c ontinued to meet one or more of the 11 DSM-IV abuse/dependence criteria, an d 3.5% went on to meet the criteria for dependence at follow-up. Among the 760 subjects with no alcohol diagnosis at baseline, 2.5% met the criteria f or alcohol dependence and 12.8% for alcohol abuse at follow-up. Baseline ch aracteristics that predicted the occurrence of any of the 11 DSM-IV abuse/d ependence criteria during the 5-year interval included male gender, lack of marital stability, presence of several of the criteria for dependence, and history of illicit drug use. Conclusions: The data suggest that over 5 years the DSM-IV diagnosis of alc ohol dependence predicts a chronic disorder with a relatively severe course , while DSM-IV alcohol abuse predicts a less persistent, milder disorder th at does not usually progress to dependence.