Stages in the alcoholic process. Toward a cumulative, nonsequential index.

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Abstract
To develop an index of a person''s position in the alcoholic process, 2440 patients (87% men, mean age 40.3) from 30 Iowa [USA] community alcoholism service centers were classified into 4 stages. Advancement in the process was measured by the number of 4 types of signs reported by the patient regardless of their sequential order: drinking-related trouble (job loss, family strife, financial difficulties; preoccupied drinking (sneaking drinks, intoxicated for days at a time; personal-effects drinking (to be less self-conscious, to get along better with others; and uncontrolled drinking (can''t stop before getting drunk, drinking more than planned). A patient who reported any 1 of these types was classified in stage I of the alcoholism process (9% of the patients); 2 types, stage II (11%); 3 types, stage III (24%); and 4 types, stage IV (46%). The remainder reported none of the types and were classed as incipient alcoholics or nonalcoholics. The predictive utility of the index was supported by logically expected associations between index scores and other variables: years since onset of preoccupied drinking, years since a patient first became aware of others'' criticism of his drinking, years since he became self-critical, years since first attending Alcoholics Anonymous and years since first deliberate effort to stop drinking (P < .01). Index scores were also associated with other variables (P < .01): patients with more advanced alcoholism were more self critical, more aware of others'' criticisms of their drinking, in poorer health, had spent more time in hospital in the last year and had more arrests. Two additional tests of the index (study A, N = 210, and study B, N = 170) demonstrated that, after treatment, abstinence rates increased with advancing stages (study A, 14% of the patients in stage I were abstinent, 26% in stage IV; study B, 9% in stage I versus 20% in stage IV) but rates of social drinking decreased with advancing stages (study A, 57% in stage I vs. 3% in stage IV; study B, 26% in stage I vs. 2% in stage IV).

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