October 10th, 2014

About Alcoholism: 4 Questions & Answers

Vaillant’s landmark 74-year longitudinal study, published most recently as Triumphs of Experience, attempted to answer many of the basic questions that  we ask in our attempt to understand and treat alcoholism:

1.     What are the best early predictors that a man will become an alcoholic?


  • The ability to tolerate large amounts of alcohol without intoxication, vomiting, or hangovers
  • Growing up in an environment that tolerated adult drunkenness and discouraged youth from learning safe drinking practices

Not predictors:

  • An unhappy childhood
  • Psychological instability
  • Psychological stability in college

2.     Is there a pre-existing addictive personality for alcoholism?


  • No premorbid personality features were found. If the person was, in fact, dependent, depressed, or sociopathic, these features developed later and were the result, not the cause, of the person’s alcoholism.

3.     How hard is it to be certain of the diagnosis of alcoholism?


  • The diagnosis can be ambiguous for the first 10 years of abusive drinking, and then the issue becomes black and white
  • Symptoms come and go. In any given month, most alcoholics are abstinent or asymptomatic, which is the problem with cross-sectional or short-term prospective studies, compared to long-term longitudinal studies such as this one.

4.     Is alcoholism always inexorably progressive?


  • No, it progresses for the first 10 years, then stays bad but does not necessarily progress. On the other hand, however, it does not get better.

In next week’s blog, I will summarize more findings from Vaillant’s wonderful book, Triumphs of Experience.

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