The Typology of Alcohol Use Disorder: Latent Class Analyses of a Population-Based Swedish Sample

The purpose of this study was to clarify the clinical heterogeneity of alcohol use disorder (AUD) in a national Swedish sample of affected individuals using latent class analysis.

Using a Swedish population-based sample of AUD cases ascertained from medical, criminal, and pharmacy registries (n = 217,071), we applied latent class analysis to sex, externalizing and internalizing syndromes before first registration, and age at first registration. The resulting types were evaluated against 15 diverse validators and degree of resemblance in relative pairs concordant for AUD.

A three-class solution was preferred by fit indices. The three classes were as follows: type 1 (male preponderant, externalizing; 32%), type 2 (minimal prior psychopathology; 46%), and type 3 (mixed-sex internalizing; 23%). Repeated split-half analyses revealed the statistical stability of these solutions. Meaningful differences emerged between the classes on many validators. Type 1 had the greatest family disruption, lowest educational levels, most AUD registrations, highest rates of criminal registration, and highest genetic risk for externalizing disorders and AUD. Type 2 had the least social dysfunction. Type 3 had the highest educational attainment, genetic liability to internalizing disorders, and proportion of women. All types significantly aggregated in affected pairs of relatives.

Meaningful and reproducible subtypes of AUD, consistent with prior typological results, can be obtained from national registry-based samples. Using a range of external validators and patterns of familial aggregation, our results suggest that our three-class solution captured a meaningful proportion of the clinical heterogeneity of AUD.