Types and phases of alcohol dependence illness.

The published data based on retrospective recall support the position that there is a characteristic developmental sequence of clinical signs and symptoms in alcohol dependence illness. These symptoms cluster in three sequential temporal phases: psychological dependence, physiological dependence, and neurological disorganization. Individuals may discontinue alcohol consumption during any phase and are not doomed to complete the sequence. Attempts to develop subtypes of alcohol-dependent individuals are generally based on inadequate samples from nonrepresentative treatment centers, many of whose patients are not alcohol dependent. The proposed essential-reactive, primary-affective, and life-style typologies have very weak support. Studies repeatedly confirm sociopathic, depressed, and anxious subgroups of alcohol dependent patients. However, such classifications have not been able to encompass more than one-half of the treatment populations studied. These concurrent symptom types are more prevalent in publicly operated treatment facilities and are predictive of recovery.