Am J Psychiatry 1994; 151:1468-1474
Copyright © 1994 by American Psychiatric Association
A comparative study of criteria for subgrouping alcoholics: the primary/secondary diagnostic scheme versus variations of the type 1/type 2 criteria
RM Anthenelli, TL Smith, MR Irwin and MA Schuckit
Department of Psychiatry, School of Medicine, University of California, San Diego.
OBJECTIVE: This study compared three methods for identifying type 1 and
type 2 alcoholism to determine how well the methods agree. It also
evaluated the comparability of each of these schemes to the
primary/secondary approach to subgrouping alcoholics. METHOD: Fifty male
alcoholic inpatients were given diagnoses of primary alcoholism without
antisocial personality disorder or primary antisocial personality disorder
with secondary alcoholism on the basis of data from structured interviews.
Operationalized criteria for type 1 and type 2 alcoholism from three groups
of researchers (Gilligan et al., von Knorring et al., and Sullivan et al.)
were also used to designate subgroups of the same subjects. RESULTS:
Subgroups of subjects classified as having type 1 or type 2 alcoholism
according to the criteria of von Knorring et al. and of Sullivan et al.
showed good levels of agreement, but the criteria of Gilligan et al.
yielded poor agreement with those of the other two schemes. Subgroups with
type 1 or type 2 alcoholism according to the criteria of Sullivan et al.
showed significant overlap with subgroups diagnosed according to the
primary/secondary alcoholism scheme: there was 73% concordance between the
type 1 subgroup and the subgroup with primary alcoholism and 73%
concordance between the type 2 subgroup and the subgroup with primary
antisocial personality disorder and secondary alcoholism. CONCLUSIONS:
There is variability in assigning diagnoses of type 1 and type 2 alcoholism
with the use of current methods. Also, type 1/type 2 classifications based
primarily on age-at-onset factors significantly overlap with the
primary/secondary classifications of alcoholics.
