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Clinical Trial
. 2005 Jun;36(2):19-26.

Treated and treatment-naive alcoholics come from different populations

George Fein  1 , Bennett Landman
Affiliations
Clinical Trial

Treated and treatment-naive alcoholics come from different populations

George Fein et al. Alcohol. 2005 Jun.

Abstract

In most research on alcoholism, convenience samples of individuals who have been in some type of treatment are used. Berkson's fallacy results when the associations found in studies of select samples are incorrectly presumed to apply to all alcoholics (i.e., including untreated alcoholics in the general population). In the current study, we examined whether treated and untreated alcoholics have similar early alcohol use histories by comparing abstinent alcoholics (treated and sober at least 6 months) with treatment-naive alcoholics (active drinkers). We studied 14 pairs of women and 25 pairs of men matched on the age at which they first met criteria for heavy alcohol use (women, 80 drinks per month; men, 100 drinks per month). The timeline follow-back interview method was used to gather retrospective alcohol use information. Alcohol dose and duration of use were subsequently computed for two intervals: (1) time between the person's first drink and date at which the person met criteria for heavy drinking and (2) period between when criteria for heavy drinking were met and current age of the treatment-naive person from each pair. During the period before the matching "heavy drinking" criteria were met, alcohol dose did not differ between groups. In the period after criteria for heavy alcohol use were met, in comparison with treatment-naive alcoholics, the treated alcoholics had higher average and peak alcohol doses. We rejected the hypothesis that the treatment-naive alcoholics and the treated alcoholics have similar alcohol use trajectories over time, with the treatment-naive sample simply being observed earlier in its alcohol use histories. Instead, we concluded that the two groups come from different populations with regard to alcohol use. In fact, the treated alcoholics had alcohol doses more than 50% higher than those of treatment-naive alcoholics in the years just after they began drinking heavily. This finding supports the suggestion that results from studies of alcoholics in treatment or after treatment (i.e., most studies of alcoholics) cannot be generalized to untreated individuals (who make up the majority of alcoholics).

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Figures

Fig. 1
Fig. 1
This figure illustrates the matching procedure. The top section of the figure presents the raw data for a matched pair of subjects (a 46 year old male abstinent alcoholic and a 34 year old male treatment naïve alcoholic) who both met criteria for heavy drinking at about 18 years of age. The middle section shows the two steps of the matching and alignment procedure. In the first step, the two subjects are aligned at their age of meeting the criteria for heavy drinking (this amounts to a shift of 4 months for the abstinent alcoholic subject), and that age is set to zero. In the second step, the data for the abstinent alcoholic subject is truncated so that it is followed for the same duration after meeting criteria for heavy drinking as was the treatment naïve subject. The bottom section shows the data after alignment and truncation.
Fig. 2
Fig. 2
Average Dose For the Period From the First Heavy Use to End of Match Period. In the matched period, the average alcohol dose was significantly lower in the treatment naïve subjects than in the treated subjects who eventually attained long-term abstinence (p<0.01). Females had lower doses than males (p<0.05), but no group by gender interactions were observed.
Fig. 3
Fig. 3
Alcohol Use Duration For the Period From the First Heavy Use to End of Match Period. In the matched period, the duration of alcohol use was lower for the abstinent alcoholics than for the treatment naïve alcoholics (p<0.01) due to increased periods of abstinence in the treated subjects who eventually attained long-term abstinence. No gender or group by gender interaction were observed.
Fig. 4
Fig. 4
This figure displays each subject’s alcohol use trajectory. When the trajectories of an abstinent alcoholic and a treatment naïve alcoholic overlap, it is indicated in red. The female trajectories are lower than male trajectories (note the difference in scale between the female and male sections of the figure). After meeting criteria for heavy drinking, the abstinent alcoholic trajectories (gray lines) are higher than the treatment naïve (orange lines) trajectories.
See this image and copyright information in PMC

Corrected and republished from

References

    1. Substance Abuse and the American Woman. Columbia University, Center on Addiction and Substance Abuse; New York: 1996.
    1. Bergman H. Brain dysfunction related to alcoholism: Some results from the KARTAD project. In: Parsons OA, Butters N, Nathan P, editors. Neuropsychology of Alcoholism: Implications for Diagnosis and Treatment. Guilford Press; New York: 1987. pp. 21–45.
    1. Berkson J. Limitations of the application of fourfold table analysis to hospital data. Biom Bull (now Biometrics) 1946;2:47–53. - PubMed
    1. Berkson J. The statistical study of association between smoking and lung cancer. Proc Staff Meet Mayo Clin. 1955;30:319–348. - PubMed
    1. Fleiss J. Statistical Methods for Rates and Proportions. Wiley; New York: 1973.

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