Use of survival analyses to examine onset and staging of DSM-IV alcohol symptoms in women.

Despite their implications for diagnostic validity, few studies have examined patterns of alcohol symptom onset in women. Using Structured Clinical Interview for the DSM-IV (M. B. First, M. Gibbon, R. L. Spitzer, & J. B. W. Williams, 1995) data, the authors applied survival analysis to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) alcohol symptoms in 87 women in treatment. Legal problems occurred rarely and did not fit a staging model. Compared with men previously studied, women showed a later onset of symptoms, which developed in 4 stages: abuse, consequation, accommodation to the illness, and physiological dependence. Three symptoms-hazardous use, larger/longer use than intended, and lots of time spent using--occurred early and may be useful for screening purposes.