Kumar Satindra, Singh R K, Goswami Utpal, Khastgir Udayan
Department of Psychiatry and Drug Deaddiction, LHMC and Associated Hospitals, New Delhi, India.
Am J Addict. 2005 May-Jun;14(3):213-22. doi: 10.1080/10550490590949550.
The natural history of alcoholism was first charted out in 1946 by Jellinek, whose original results have been replicated by multiple research groups. They have verified a general progression of alcohol dependence through a series of identifiable phases. The study investigated the sequence of events in the course of alcohol dependence and its deviations from randomness. The study consisted of 36 patients with alcohol dependence, subjected to a structured questionnaire containing 34 items describing the phenomenology of alcohol dependence, based on the lines of SCID. The items experienced by each patient were identified and then plotted on a timeline graph according to an important life event, the items being represented on cards given to the patients randomly. The subjects were re-interviewed after one week and asked to rank their symptoms again to analyze test-retest reliability. The analysis of the item ordering was determined by null hypothesis of randomness. The ordering showed three phases. The early phase was characterized by features of increased tolerance loss of flexibility, and salience. The middle phase consisted mainly of the need for alcohol, and the late phase was predominated by features of physiological withdrawal, tremors, nausea, panics, and hallucinations. There is a characteristic ordering of new events and symptoms, which suggests a developmental process of alcoholism, but this is apparent only if attention is confined to a limited part of the broad spectrum. This process is obscured by consideration of the social concomitants of alcohol dependence. The study of the natural history of alcohol dependence is essential in recognizing and treating the problem and determining whether an intervention appears to be working.
1946年，杰利内克首次描绘了酗酒的自然病程，其原始研究结果已被多个研究团队重复验证。他们证实了酒精依赖会经历一系列可识别阶段的一般发展过程。该研究调查了酒精依赖过程中的事件顺序及其与随机性的偏差。该研究包括36名酒精依赖患者，他们接受了一份包含34个项目的结构化问卷，该问卷基于精神疾病诊断与统计手册的思路描述了酒精依赖的现象学。确定每位患者经历的项目，然后根据一个重要生活事件将这些项目绘制在时间线图上，项目随机分配给患者并制成卡片呈现。一周后对受试者进行再次访谈，并要求他们重新对症状进行排序，以分析重测信度。通过随机性的零假设来确定项目排序的分析。排序显示出三个阶段。早期阶段的特征是耐受性增加、灵活性丧失和显著性增强。中期主要是对酒精的需求，后期则以生理戒断、震颤、恶心、恐慌和幻觉为主要特征。新事件和症状存在一种特征性的顺序，这表明酗酒有一个发展过程，但只有将注意力局限于广泛范围的有限部分时才明显。考虑到酒精依赖的社会伴随因素，这个过程就会变得模糊不清。研究酒精依赖的自然病程对于认识和治疗该问题以及确定干预措施是否有效至关重要。
