Course and Natural History
Schuckit and colleagues (1993) found that the
symptoms of al-cohol dependence appear in the following sequence in a sample of
male veteran alcoholics: heavy drinking during the late twen-ties; interference
with functioning in multiple life areas during their early thirties; loss of
control, followed by an intensifica-tion of social and work-related problems,
and onset of medical consequences in the mid- to late thirties; and severe
long-term consequences by the late thirties and early forties. However, as
mentioned above, women appear to experience many of these milestones at a later
age than men. The study by Schuckit and col-leagues showed no effect of onset
age, family history of alcohol- ism, or comorbid psychiatric diagnoses on the
order of symptom appearance. However, other features defining the course of
alco-holism, particularly the response to treatment, vary as a function of
patient-related variables, including age of onset, severity of alcohol dependence
and comorbid psychiatric disorders. There is consistent evidence that early age
of onset is a predictor of greater severity of alcoholism and a poorer response
to treatment.
Although a number of studies have shown that
patients experience substantial improvement during the year following
alcoholism treatment (Lindstrom, 1992), Vaillant (1983) found that treatment
had minimal effects on long-term outcome. More long-term treatment outcome
studies are needed to examine the impact of different kinds of alcoholism
treatment on the course of the disorder. Additional studies are also needed to
clarify both the prognostic significance of patient-related variables,
including comorbid psychiatric disorders, and their interaction with differ-ent
kinds of treatment.
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