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Ronald C. Kessler, PhD; Rosa M. Crum, MD, MHS; Lynn A. Warner, MPP; Christopher B. Nelson, PhD, MPH; John Schulenberg, PhD; James C. Anthony, PhD

Arch Gen Psychiatry. 1997;54(4):313-321.

Abstract
Objective
To study patterns of co-occurrence of lifetime DSM-III-R alcohol disorders in a household sample.

Methods
Data came from the National Comorbidity Survey (NCS), a nationally representative household survey. Diagnoses were based on a modified version of the Composite International Diagnostic Interview.

Results
Respondents with lifetime NCS/DSM-III-R alcohol abuse or dependence had a high probability of carrying at least 1 other lifetimeNCS/DSM-III-R diagnosis. Retrospective reports have suggested that most lifetime co-occurring alcohol disorders begin at a later age than at least 1 other NCS/DSM-III-R disorder. Earlier disorders are generally stronger predictors of alcohol dependence than alcohol abuse and stronger among women than men. Lifetime co-occurrence is positively, but weakly, associated with the persistence of alcohol abuse among men and of alcohol dependence among both men and women.

Conclusions
Caution is needed in interpreting the results due to the fact that diagnoses were made by nonclinicians and results are based on retrospective reports of the age at onset. Within the context of these limitations, though, these results show that alcohol abuse and dependence are often associated with other lifetime DSM-III-R disorders and suggest that, at least in recent cohorts, the alcohol use disorders are usually temporally secondary. Prospective data and data based on clinically confirmed diagnoses are needed to verify these findings.

Author Affiliations
From the Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Kessler); the Departments of Epidemiology (Dr Crum), Psychiatry (Dr Crum), and Mental Hygiene (Drs Crum and Anthony), School of Hygiene and Public Health, and the Department of Psychiatry and Behavioral Sciences, School of Medicine (Drs Crum and Anthony), The Johns Hopkins University, Baltimore, Md; Department of Sociology (Ms Warner), and Institute for Social Research (Dr Schulenberg), School of Social Work, University of Michigan, Ann Arbor; and the Max Planck Institute of Psychiatry—Clinical Institute, Munich, Germany (Dr Nelson).

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ABSTRACT | FULL TEXT  

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ABSTRACT | FULL TEXT  

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Am. J. Psychiatry 1998;155:613-619.
ABSTRACT | FULL TEXT  

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Am. J. Psychiatry 1998;155:62-69.
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