ALCOHOL SUBTYPES--STUDY OF CLINICAL VALIDITY

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Alcoholics are a heterogeneous group in terms of several dimensions including family history, comorbid psychopathology, and drinking history. A useful and reliable classification system for alcoholics would facilitate patient-treatment matching and research on etiology of alcoholism. A number of subtyping schemas have been proposed, and none have been accepted as definitive. In fact,several prevailing multidimensional typologies have not yet been replicated adequately. Only two reported studies have tested competing typologies in terms of discriminant and predictive validity. There has no attempt to integrate proposed typologies into a rational set of non-redundant subtyping schemas. Furthermore, there has been inconsistency in ways used to operationalize specific subtypes and in the diagnostic methodology used to classify subjects. The primary aims of the current study are: (1) to test replicability of two multidimensional, empirically derived typologies (Type A/B/, and I/II). two multidimensional, theoretically derived typologies (bidimensional and polysyndromatic models), and four unidimensional, theoretically derived typologies (antisocial personality disorder (ASP) versus nonASP, early versus late onset, family history (FH) positive versus FH negative, and gender) in a number of treatment settings and understudied samples; and (2) to test predictive validity of prevailing typologies within diverse treatment settings. Typologies will be compared vis a vis one another regarding the variance they account for in treatment outcome, and vis a vis other prognostic indicators such as age, education, and treatment factors. Treatment outcome is measured via multiple domains including drinking, psychosocial functioning, and treatment compliance. Secondary aims of the current study include: (3) to examine convergence (overlap) among typologies, and (4) to test discriminant validity of replicated subtypes. The study will use baseline (BL) and follow-up (FU) data collected from four separate treatment- outcome studies at the Rutgers University Alcohol Research Center (ARC), plus data from a supplementary sample for whom BL and FU data will be collected as part of the current grant. The total sample of 775 subjects thus includes 675 ARC and 100 supplemental subjects (548 men and 227 women) who will undergo a common "core assessment battery" for BL and FU information on drinking history, comorbid psychopathology, personality and temperament, family history of alcohol and drug use disorders, antisocial personality and depression, and psychosocial functioning.