Theoretical and observed subtypes of DSM-IV alcohol abuse and dependence in a general population sample

The purpose of this study was to quantify the degree of heterogeneity of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) alcohol abuse and dependence categories by comparing the number of theoretically predicted subtypes of each category with those observed in a nationally representative sample of the US general population. Among respondents classified with a past year diagnosis of abuse, only 11 (47.8%) of the 23 theoretically predicted subtypes of abuse were observed, while 53 (53.5%) of the 99 theoretically predicted subtypes of dependence were observed in this general population sample. Approximately 90% of the respondents classified with abuse could be represented by three subtypes of abuse and 70% of the respondents with current diagnoses of dependence could be characterized by six subtypes of dependence, indicating the relative homogeneity of both diagnostic categories. Sociodemographic differentials were also observed including the reduction in the number of observed subtypes of abuse and dependence with age as well as the larger numbers of subtypes associated with males and whites relative to females and blacks, respectively. Implications of these results are discussed in terms of increased physical morbidity and disruption of family life as persons with alcohol use disorders age, the potential role of physiological and impaired control over drinking indicators of dependence as critical features of the disorder, and the future need to examine the conceptual basis of the abuse category and to conduct longitudinal epidemiological research.