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PhD Thesis - Sannibale, C

An evaluation of Cloninger's typology of alcohol abuse
Sallibale C (1995)

Abstract:
Cloninger's (1987a) typology of alcoholism was evaluated using the classification criteria developed by Gilligan, Reich and Cloninger (1987) in two cross sectional studies of men and women who met criteria for a lifetime diagnosis of DSM-III-R alcohol abuse/dependence. The first study of 300 men and women evaluated the comprehensiveness and specificity of the typology and tested a number of predictions from Cloninger's model of alcoholism. Two methods of classification were attempted, based on the Alcohol Symptom Scale (Gilligan et al., 1987). They either provided poor coverage of the sample (18%), or misclassified one quarter of the sample.

Predictions concerning differences between Type 1 and Type 2 problem drinkers in pattern of alcohol abuse, gender, personality characteristics, and familial aggregation of alcohol abusers were tested with univariate and multivariate analyses. There was little support for the predicted Type 1/Type 2 differences. More women than men were classified as Type 1 problem drinkers (19.3% vs 6.0%), but, contrary to expectations, similar numbers were classified as Type 2 problem drinkers (6.7% vs 4.0%). As predicted, Type 2 problem drinkers had more symptoms of antisocial personality disorder (ASPD); more social consequences of drinking; and higher Disinhibition scores than Type 1 problem drinkers. Schuckit's contention that Type 2 problem drinkers differed from problem drinkers with ASPD only by the extent of their ASPD symptomatology was supported.

As predicted, women had a later age at onset of alcohol abuse/dependence (23 vs 20 years), but women and men had a similar time lag between the onset of regular drinking and that of problem drinking, and similar levels of alcohol dependence. However, women reached the same levels of dependence in fewer years (11 vs 17 years).

The second study (n=50) evaluated the personality characteristics of Cloninger's (1987a) model of alcoholism, using his recently developed Temperament and Character Inventory (TCI). Type 1 and Type 2 problem drinkers were compared on the dimensions novelty seeking, harm avoidance and reward dependence. The TCI was also compared to the Sensation Seeking Scale to assess Zuckerman's (1988) assertion of an overlap between these two instruments.

Only two predictions were supported. Women had higher reward dependence scores than men, and novelty seeking was positively correlated with Type 2 alcohol abuse. Novelty seeking and sensation seeking were found to be very similar constructs, as Zuckerman had claimed.

The possibility that the typology may represent degree of severity of problem drinking was also tested. This was supported, since the typology predicted the severity of lifetime alcohol abuse/dependence independently of other variables. Lastly, an alternative and simpler typology to Cloninger's, that of Stabenau's (1990), was tested using the data from the first study. The data were adequately accounted for by a model containing sex, age, ASPD, family history of problem drinking, age of onset of alcohol abuse/dependence, lifetime number of additional psychiatric diagnoses, and the interaction between FHA and ASPD. This model accounted for 21% of the variance in the severity of alcohol abuse/dependence.

In conclusion, sex, age, ASPD, FHA, and age at onset, and the number of psychiatric disorders were found to be dimensions predictive of the severity of alcohol abuse/dependence but there was little support for Cloninger's typology.

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