Classification and course of alcohol problems among adolescents in addictions treatment programs

Background: This study tested whether adolescents in addictions treatment programs could be reliably classified into milder and more severe alcohol problem categories using latent class analysis, and examined the relation of latent class structure to DSM-lV alcohol diagnoses. Transition probabilities among the latent classes at 1-year follow-up and their predictors were used to characterize the short-term course of alcohol problems. Methods: Adolescents recruited from addictions treatment were administered a modified section of the Structured Clinical Inter-view for the DSM (SCID) alcohol use disorders (AUD) during or shortly after addiction, treatment and at 1-year follow-up. DSM-IV lifetime conduct disorder diagnosis was assessed at baseline using a modified version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). Results: A 3-class solution that represented increasing severity of alcohol problems (i.e., asymptomatic, mild, and severe) provided the best fit to the alcohol symptom data, and was consistent across gender, ethnicity. and presence of conduct disorder. Cross-classification of latent class membership with DSM-lV alcohol diagnosis indicated only a fair level of agreement. There was an overall decrease in alcohol problem severity from baseline to follow-up. Conditional transition probabilities indicated that males and those with conduct disorder. particularly for those in the severe class at baseline, had it lower likelihood of transitioning to the asymptomatic class at 1-year follow-up. Conclusions: The latent class structure of alcohol problem, in an adolescent clinical sample was best represented by a 3-class severity-based model. Cross-classification of latent class membership with DSM-lV alcohol diagnosis suggests the potential utility of re-organizing diagnostic criteria to better distinguish the relative severity of abuse and dependence diagnoses. Transitions between latent classes were fairly common at 1-year follow-up, and characterized by a general reduction in alcohol symptoms.