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.