Kessler R C, Crum R M, Warner L A, Nelson C B, Schulenberg J, Anthony J C
Department of Health Care Policy, Harvard Medical School, Boston, Mass, USA.
Arch Gen Psychiatry. 1997 Apr;54(4):313-21. doi: 10.1001/archpsyc.1997.01830160031005.
To study patterns of co-occurrence of lifetime DSM-III-R alcohol disorders in a household sample.
Data came from the National Comorbidity Survey (NCS), a nationally representative household survey. Diagnoses were based on a modified version of the Composite International Diagnostic Interview.
Respondents with lifetime NCS/DSM-III-R alcohol abuse or dependence had a high probability of carrying at least 1 other lifetime NCS/DSM-III-R diagnosis. Retrospective reports have suggested that most lifetime co-occurring alcohol disorders begin at a later age than at least 1 other NCS/DSM-III-R disorder. Earlier disorders are generally stronger predictors of alcohol dependence than alcohol abuse and stronger among women than men. Lifetime co-occurrence is positively, but weakly, associated with the persistence of alcohol abuse among men and of alcohol dependence among both men and women.
Caution is needed in interpreting the results due to the fact that diagnoses were made by nonclinicians and results are based on retrospective reports of the age at onset. Within the context of these limitations, though, these results show that alcohol abuse and dependence are often associated with other lifetime DSM-III-R disorders and suggest that, at least in recent cohorts, the alcohol use disorders are usually temporally secondary. Prospective data and data based on clinically confirmed diagnoses are needed to verify these findings.
研究家庭样本中终生 DSM-III-R 酒精障碍的共病模式。
数据来自全国共病调查（NCS），这是一项具有全国代表性的家庭调查。诊断基于综合国际诊断访谈的修改版本。
有终生 NCS/DSM-III-R 酒精滥用或依赖的受访者极有可能至少患有 1 种其他终生 NCS/DSM-III-R 诊断。回顾性报告表明，大多数终生共病的酒精障碍开始的年龄比至少 1 种其他 NCS/DSM-III-R 障碍晚。较早出现的障碍通常比酒精滥用更能预测酒精依赖，且在女性中比在男性中更强。终生共病与男性酒精滥用以及男性和女性酒精依赖的持续存在呈正相关，但关联较弱。
由于诊断由非临床医生做出且结果基于发病年龄的回顾性报告，因此在解释结果时需要谨慎。不过，在这些局限性的背景下，这些结果表明酒精滥用和依赖通常与其他终生 DSM-III-R 障碍相关，并且表明至少在最近的队列中，酒精使用障碍通常在时间上是继发性的。需要前瞻性数据和基于临床确诊诊断的数据来验证这些发现。
