Patterns of Familial Alcoholism, Alcoholism Severity, and Psychopathology

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The interrelationships among the severity of alcoholism, psychopathology/personality, and the degree of familial alcoholism were examined using the following four familial alcoholism classification schemes, which each differentiated three degrees of familial alcoholism: 1) conventional, compared alcoholics with no, nonparental, and parental alcoholic relatives; 2) lineality, distinguished between subgroups with alcoholism in neither, one, or both sides of their family; 3) generational, compared alcoholics having no, one, or two generations of familial alcoholism; 4) quantitative, credited one point for each first-degree and 1/2 point for each second-degree alcoholic relative.The subjects were 83 male alcoholic Veterans Administration inpatients 50 years of age or under. The Alcohol Use Inventory, various alcohol-related symptoms and behaviors, and laboratory values were used to evaluate the severity/pattern of alcoholism. Psychopathology/personality were measured by the MMPI, the Psychopathic State Inventory, the Mac-Andrew Alcoholism Scale, the Childhood Problem Behaviors Questionnaire, and the percentage of patients with an antisocial personality disorder (ASP) diagnosis.Surprisingly few subgroup differences were revealed in the severity/pattern of alcoholism. Only age at time of treatment and use of nonalcoholic drugs were associated with increasing familial alcoholism. On the other hand, childhood behavior problems, particularly antisocial behavior, and an ASP diagnosis were found to be associated with an increasing degree of familial alcoholism. The diagnosis of ASP was most apparent in the two-generational and bilineal alcoholics, while an increased degree of familial alcoholism was not associated with ASP for the conventional classification. Bilineal familial alcoholics also exhibited an MMPI profile reflective of a characterological disorder. The lineality classification appeared to be the most sensitive and the conventional scheme the least sensitive to differentiations in the variables studied. These findings underline the limitations of dichotomous classifications for the study of familial alcoholism. Two explanations for the high prevalence of ASP in bilineal and two-generational familial alcoholics are discussed—the character spectrum disorder hypothesis vs. the independent transmission of ASP.

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