Abstract
The natural history of alcoholism was first charted out in 1946 by Jellinek, whose original results have been replicated by multiple research groups. They have verified a general progression of alcohol dependence through a series of identifiable phases. The study investigated the sequence of events in the course of alcohol dependence and its deviations from randomness. The study consisted of 36 patients with alcohol dependence, subjected to a structured questionnaire containing 34 items describing the phenomenology of alcohol dependence, based on the lines of SCID. The items experienced by each patient were identified and then plotted on a timeline graph according to an important life event, the items being represented on cards given to the patients randomly. The subjects were reinterviewed after one week and asked to rank their symptoms again to analyze test-retest reliability. The analysis of the item ordering was determined by null hypothesis of randomness. The ordering showed three phases. The early phase was characterized by features of increased tolerance loss of flexibility, and salience. The middle phase consisted mainly of the need for alcohol, and the late phase was predominated by features of physiological withdrawal, tremors, nausea, panics, and hallucinations. There is a characteristic ordering of new events and symptoms, which suggests a developmental process of alcoholism, but this is apparent only if attention is confined to a limited part of the broad spectrum. This process is obscured by consideration of the social concomitants of alcohol dependence. The study of the natural history of alcohol dependence is essential in recognizing and treating the problem and determining whether an intervention appears to be working. (Am J Addict 2005;14:213–222)