Alcohol-related problems and dependence: an elaboration and integration.

This study sought to more clearly specify and integrate the domain of behaviors that comprise the American Psychiatric Association's DSM-III definition (substance abuse and dependence) and the World Health Organization's definition (alcohol dependence syndrome) of alcoholism. To accomplish this, self-report measures were constructed that assessed the alcohol-related psychosocial problems outlined in the DSM-III as largely necessary for a diagnosis of substance abuse/dependence. The mostly physiological features of alcohol dependence were measured by four scales that reflected key elements in both definitions. After determining that these instruments possessed adequate psychometric properties, the project explored the relationships among alcohol-related problems and dependence within a sample of 420 male and female inpatient alcoholics. Alcohol dependence and psychosocial consequences were substantially correlated. Maximum-likelihood factor analysis suggested a model of three correlated factors that included the physiological components of dependence defined by symptoms of withdrawal, obsessive drinking, and alcohol-related health problems; alcohol-related family/social problems coupled with loss of behavioral control while drinking; and economic/job problems. A fourth and largely independent factor of alcohol-related legal problems also emerged.