The assessment of alcoholism in surveys of the general community: What are we measuring? Some insights from the Australian twin panel interview survey

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Abstract
The majority of cases identified by commonly used alcoholism criteria in general community surveys are mild ones, with few alcohol-related problems. We illustrate this using data on 2088 Australian male twins aged 28–89 (mean age = 42.7), including 1846 who reported more than minimal alcohol exposure when surveyed by telephone in 1992–3. Using latent class analysis of alcoholism symptoms reported by these twins, we identify five classes of respondent: those with no alcohol-related problems (49% of the sample, if we include those with minimal alcohol exposure); excessive drinkers (33%); and individuals with a history of mild (14%), moderate (3%) or severe problems (1%). Symptom endorsement profiles associated with these different classes are illustrated. The two most severe classes constitute a substantial majority of those reporting alcoholism treatment, but a minority of those reporting alcohol-related auto accidents or injuries, recurrent hazardous alcohol use, or alcohol-related arrests. The excessive drinkers and persons with mild problems account for a much higher proportion of persons experiencing these outcomes, and thus represent an important group to study from a public health perspective. The use of latent class analysis to improve case detection using structured or semi-structured diagnostic instruments is also discussed.