OBJECTIVE: In this study, we sought to identify specific clinical features of alcohol dependence and other characteristics of recent drinkers that might help differentiate drinkers who receive treatment. METHOD: In 1998, field staff for the National Household Survey on Drug Abuse assessed 18,722 sampled adults, including 12,437 who reported drinking in the year prior to survey, most of whom self-marked answers to standard items on drug experiences, including clinical features of alcohol dependence and receipt of treatment. Statistical analyses took into account the complex sampling procedures and the interdependencies between individual responses. RESULTS: Multivariate modeling with generalized linear model and generalized estimating equations with statistical adjustment for age, gender and race revealed that individuals who received treatment reported all seven clinical features more often than drinkers who did not receive treatment, with the greatest differences observed for alcohol-related emotional problems (adjusted odds ratio [adj. OR] = 15.0), health problems (adj. OR = 13.5), reduced important activities (adj. OR = 10.4) and inability to cut down (adj. OR = 10.1) (all p values < .05). The observed treatment-related differences were less pronounced for other clinical features (e.g., reported tolerance [adj. OR = 4.8], using more than was intended [adj. OR = 6.2] and salience of alcohol-related behavior [adj. OR = 6.2]; all p values < .05). Further statistical adjustment for frequency of alcohol use and age of first alcohol use did not alter these estimates appreciably. CONCLUSIONS: Reasons for observed excess occurrence of alcohol-related problems among community samples of drinkers who receive treatment deserve more attention in future research. A key research question is whether self-awareness of alcohol-related problems motivates drinkers to seek treatment or if treatment promotes awareness and decreases denial about alcohol problems.
OBJECTIVE: In this study, we sought to identify specific clinical features of alcohol dependence and other characteristics of recent drinkers that might help differentiate drinkers who receive treatment. METHOD: In 1998, field staff for the National Household Survey on Drug Abuse assessed 18,722 sampled adults, including 12,437 who reported drinking in the year prior to survey, most of whom self-marked answers to standard items on drug experiences, including clinical features of alcohol dependence and receipt of treatment. Statistical analyses took into account the complex sampling procedures and the interdependencies between individual responses. RESULTS: Multivariate modeling with generalized linear model and generalized estimating equations with statistical adjustment for age, gender and race revealed that individuals who received treatment reported all seven clinical features more often than drinkers who did not receive treatment, with the greatest differences observed for alcohol-related emotional problems (adjusted odds ratio [adj. OR] = 15.0), health problems (adj. OR = 13.5), reduced important activities (adj. OR = 10.4) and inability to cut down (adj. OR = 10.1) (all p values < .05). The observed treatment-related differences were less pronounced for other clinical features (e.g., reported tolerance [adj. OR = 4.8], using more than was intended [adj. OR = 6.2] and salience of alcohol-related behavior [adj. OR = 6.2]; all p values < .05). Further statistical adjustment for frequency of alcohol use and age of first alcohol use did not alter these estimates appreciably. CONCLUSIONS: Reasons for observed excess occurrence of alcohol-related problems among community samples of drinkers who receive treatment deserve more attention in future research. A key research question is whether self-awareness of alcohol-related problems motivates drinkers to seek treatment or if treatment promotes awareness and decreases denial about alcohol problems.