The Natural History of Alcoholism
Vaillant, George E., Hiller-Sturmhofel, Susanne, Alcohol Health & Research World
Over the past 55 years, two longitudinal studies have been monitoring the drinking behaviors and their consequences of several hundred men from adolescence and early adulthood to old age. The studies identified co-occurring sociopathy, cultural factors (e.g., ethnicity), and genetic factors (ie., a family history of alcoholism) as risk factors for alcoholism. In most alcoholics, the disease had a progressive course, resulting in increasing alcohol abuse or stable abstinence. However, some alcoholics exhibited a nonprogressive disease course and either maintained a stable level of alcohol abuse or returned to asymptomatic drinking. Long-term return to controlled drinking, however, was a rare and unstable outcome. Formal treatment, with the exception of attending Alcoholics Anonymous, did not appear to affect the men's long-term outcomes, whereas several non-treatment-related factors were important for achieving stable recovery. KEY WORDS: AOD dependence; disease course; longitudinal study; prospective study; risk factors; etiology; familial alcoholism; sociocultural AODC (causes of AOD use, abuse, and dependence); family environment; antisocial behavior; emotional and psychiatric depression; college student; urban area; heavy AOD use; AOD abstinence; Alcoholics Anonymous; treatment goals
In many ways, alcoholism differs from most other diseases. First, it generally develops slowly over a person's life and can occur in people of all ages. Second, it has no single known cause: Heredity, culture, economics, and the environment all contribute to its development, and each alcoholic has his or her own personal drinking history. Third, both alcoholics and their alcohol-related disabilities can change over time. For example, alcohol can have long-term effects on the central nervous system that may alter an alcoholic's personality and perception of the past. Finally, no known cure exists; although some patients recover either "spontaneously" or after treatment, many patients never recover. In an effort to increase our understanding of alcoholism and develop more effective prevention and treatment programs, alcohol researchers are studying the development and course of the disease in people of various ages.
Several different methodological approaches can be used for investigating alcoholism and its characteristics, including cross-sectional and longitudinal studies. Cross-sectional studies examine large numbers of subjects of various ages and social backgrounds representative of the general population. Longitudinal studies, in contrast, usually include smaller and less representative samples, but the subjects are followed over longer periods (e.g., up to 50 years) and reexamined repeatedly. Thus, although the overall sample may be biased, the disease progress in each person can be documented in more detail.
Alcohol studies also vary by whether the subjects are evaluated retrospectively or prospectively. In retrospective studies, researchers select subjects with a specific disorder (e.g., alcoholism) and, using interviews, medical records, and other sources of information, try to determine the factors that contributed to the disease's development. Conversely, the subjects of prospective studies are disease free at the study's outset; accordingly, some subjects will develop the disorder under investigation, whereas others will not. This approach allows researchers to analyze the premorbid characteristics of both groups of subjects.
Most analyses of the development and course of alcoholism have used a cross-sectional, retrospective design, with researchers recruiting alcoholics (e.g., from treatment facilities) and establishing their drinking histories. This approach may not always produce reliable results, however, because alcoholism is a chronic disease that changes in its severity and manifestations over time. Consequently, chronic alcohol consumption may gradually alter an alcoholic's personality. Furthermore, guilt, misattribution, and the passage of time can cause unwitting misrepresentation of an alcoholic's characteristics before disease onset. …