Alcohol dependence and abuse in three groups at varying familial alcoholism risk.

Three groups of young men varying in familial alcoholism risk were compared for lifetime and current Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) diagnoses. A withdrawal gate diagnostic model (WGM) requiring withdrawal for a dependence diagnosis was also evaluated. Extremely high lifetime DSM-IV diagnostic rates were found for all groups (greater than or equal to78%), with the highest rate in the highest risk group. Similar group differences obtained for individual criteria or symptoms. Although lifetime diagnostic rates were similar for the WGM and DSM-IV, virtually all cases of dependence were preceded by abuse for the WGM, unlike DSM-IV. The findings underline the importance of distinguishing degrees of familial alcoholism risk. The WGM model temporal onset findings versus DSM-IV and the high lifetime diagnostic rates obtained suggest some limitations of the DSM-IV diagnoses.