Staging in the onset of DSM-IV alcohol symptoms in adolescents: Survival/hazard analyses

Objective: This research examined staging in the time to onset of DSM-IV alcohol symptoms in adolescents. Consistent staging in the onset of symptoms provides important tests of the construct validity of diagnostic systems, and aids the development of early case identification strategies. Method: The Structured Clinical Interview for the DSM (SCID), adapted to assess DSM-IV alcohol abuse and dependence symptoms, was used to determine time to symptom onset in 102 male and 97 female adolescent drinkers with and without alcohol use disorders. The sample provided a broad range of drinking practices and alcohol-related problems. Symptom onset patterns were examined using survival-hazard analyses. Results: Survival and hazard data suggested three stages of alcohol problems distinguished by time to onset: heavy and heedless drinking with associated social and role obligation problems, psychological dependence, and withdrawal. This three-stage model fit both the male and female data, and described staging patterns in 70% of the subjects. Conclusions: The symptom onset model suggested a first stage of adolescent alcohol symptoms characterized by heavy and heedless drinking with associated interpersonal and role obligation problems. The data did not support the construct validity of DSM-IV alcohol abuse when applied to adolescents, and suggested staging among DSM-IV alcohol dependence symptoms. Implications for the diagnosis and early identification of adolescent alcohol problems are discussed.