Grant B F, Chou S P, Pickering R P, Hasin D S
Division of Biometry and Epidemiology, National Institute on Alcohol, Abuse and Alcoholism, Rockville, MD 20852.
Drug Alcohol Depend. 1992 Apr;30(1):75-84. doi: 10.1016/0376-8716(92)90039-f.
The purpose of the present study was to quantify the degree of heterogeneity of the DSM-III-R alcohol dependence category by comparing the number of potential subtypes of dependence to those empirically observed in a general population survey. Forty-one percent (n = 189) of the 466 potential subtypes of DSM-III-R alcohol dependence were observed, indicating that the category is indeed heterogeneous, but not as heterogeneous as theoretically predicted. Variations in the number, percent and configuration of empirical subtypes of dependence are discussed in terms of coincident morbidity, premature death from alcoholism or death from other competing causes, reporting biases and differences in drinking patterns. The predominance of the 'tolerance' 'withdrawal' and 'impaired control over drinking' criteria among the empirically observed subtypes of dependence are examined within the context of the physiological dependence subtype proposed for the DSM-IV category of alcohol dependence and difficulties encountered in operationalizing these diagnostic criteria. The relevance of study findings to the validation of diagnostic categories in psychiatry is also highlighted.
本研究的目的是通过比较依赖的潜在亚型数量与在一项普通人群调查中实际观察到的数量，来量化《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中酒精依赖类别的异质性程度。在DSM-III-R酒精依赖的466种潜在亚型中，有41%（n = 189）被观察到，这表明该类别确实具有异质性，但不像理论预测的那么异质。从共病、酒精中毒过早死亡或其他竞争原因导致的死亡、报告偏差以及饮酒模式差异等方面讨论了依赖的实际亚型在数量、百分比和构成上的变化。在为DSM-IV酒精依赖类别提出的生理依赖亚型的背景下，以及在实施这些诊断标准时遇到的困难，研究了在实际观察到的依赖亚型中“耐受性”“戒断”和“对饮酒控制受损”标准的主导地位。还强调了研究结果与精神病学诊断类别的验证的相关性。
