Note on the ordering of onset of symptoms in alcohol dependence

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Abstract
SYSNOPSIS Jellinek's proposed phases in the development of alcohol dependence covered a wide diversity of areas. Trice and Wahl and others have rejected these detailed proposals on the grounds that not all alcoholics experience all symptoms and those that do experience them do not necessarily experience them in the same order. Data from 59 halfway house residents confirmed these two points. However, a small number of clusters of items were isolated which were reported to occur in characteristic sequence. These were: firstly, the onset of psychological dependence; secondly, tremor, morning drinking, and amnesia; and, thirdly, aspects of alcoholic psychosis. The conclusion is that there is a characteristic ordering of new events and symptoms suggestive of a developmental process in alcoholism, but this ordering is apparent only if attention is confined to a limited part of the broad spectrum of events and symptoms associated with alcoholism. This process is obscured by a consideration of the social concomitants of alcohol dependence.

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