Toward an integrative model for alcohol use and dependence

doi:10.4236/ojpsych.2012.24044

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Open Journal of Psychiatry, 2012, 2, 317-320 OJPsych

http://dx.doi.org/10.4236/ojpsych.2012.24044 Published Online October 2012 (http://www.SciRP.org/journal/ojpsych/)

Toward an integrative model for alcohol use and

dependence

Serge Combaluzier

Department of Psychology, University of Rouen, Rouen, France

Email: [email protected]

Received 21 July 2012; revised 25 August 2012; accepted 5 September 2012

ABSTRACT

Background: If the alcohol use and dependence disor-

ders are differentiated by the pharmaco-dependence,

they share complex relationships with other clinical

disorders and personality disorders. The purpose of

this paper is to produce a model that reflects its rela-

tions both among users than among addicts. Method:

Data from questionnaires measuring key variables

selected for this study have been collected from peo-

ple with alcohol misuse (n = 83) and alcohol-depen-

dent (n = 81) in rehab. A model of drug dependence

has been produced from these data that gives com-

plete satisfaction to the criteria of SEM. Discussion:

This model reflects the shift from abuse to a depen-

dent consumption by the presence of feedbacks in-

volving pharmaco-dependence, disturbance of the al-

cohol consumption by psychological distress and de-

pressive traits. To further guarantee its validity, how-

ever it should be tested by collecting data from other

surveys.

Keywords: Structural Equation Modelling; Alcohol

Abuse; Alcohol Dependence

1. INTRODUCTION

Several decades of studies on alcohol related disorders

have collected much evidence of their interactions with

clinical features, especially anxious or depressive (Hall,

Degenhardt and Tesson, 2009 [1]; Schukit et al., 2009 [2];

Allan, 1995 [3]; Schuckit et al., 1994 [4]; Brady &

Lydiard, 1993 [5]; Turbull & Gomberg, 1990 [6]; Helzer

& Pryzbeck, 1990 [7]) or personality features (Dejong et

al., 1993 [8]; Movalli et al., 1996 [9]) on alcohol use dis-

orders. There are two concurrent interpretations for these

co-morbidities. For some authors the mental disorders

are primary to this addiction, for some others they are

secondary that means induced by the alcoholism (F10.8).

Alcoholic behaviours have been studied through the

motives for drinking. They are implied in the disturbance

of the alcoholic behaviours and can lead, as Goldsmith,

Tran, Smith and How (2009) [10] have explained re-

cently to major problems in alcohol drinking among young-

er people. Of course, other motives for drinking have

been identified according to Pelc (1978) [11]: Search for

social contacts, taste for alcohol, psychological prob-

lems, sensation seeking, and pharmaco-dependency.

This last factor is one of the main differential diagnostic

between alcohol use (F10.1) and alcohol dependence

(F10.2.x).

The aim of this study is to produce a model of this

main symptom that includes both the alcoholic beha-

viours and their components, clinical and personality

features, and that can explain these among people with

alcohol abusing or depending disorders.

2. METHOD

To measure the disturbance of alcoholic behaviour and

the motives for drinking, we have used the Questionnaire

of the Habits of Alcoholic Drink, devised by Pelc [11].

This self-questionnaire explores 5 dimensions of the mo-

tives for drinking, as described above, and provides a

score for the disturbance of the alcoholic behaviour. Ac-

cording to Pelc, a score higher than 24 reflects an ab-

normal drinking behaviour. To measure the intensity of

the clinical features we have used the French version

(Pariente and Guelfi, 1998 [12]) of Derogatis’s Symptoms

Check List 90r [13] that estimates the intensity of such

clinical features as somatisation, obsession, sensitivity,

hostility, anxiety, depression phobia, psychosis or para-

noia. Finally, for to estimate the personality disorders we

have used the French version (Cottraux et al., 1985 [14])

of the Dysfunction Attitude Scale (DAS) by Weisman

and Beck (1978) [15].

Then, we have presented these questionnaires to a

large sample (n = 81) of persons in detoxification for

their alcohol-dependencies and to a large sample (n = 83)

of people who drink alcohol in public houses, bars or

night clubs. After randomization, we kept 40 protocols of

the first group and 52 of the second one.

OPEN ACCESS

S. Combaluzier / Open Journal of Psychiatry 2 (2012) 317-320

318

The data were processed using statistical software, SPSS®

and the step by step regressions method led us to a model

of the pharmaco-dependency that we have computed in a

structural equation modelling software (Amos®), follow-

ing Arbuckle’s criteria [16] for validation of structural

model: non significant chi-square; GFI and CFI closed to

1, RMSEA closed to 0.

3. RESULTS

The global outcomes are summed up in the following

table (Table 1):

Since the distribution of the outcomes on the DAS of

Weisman and Beck is not normal, the intensity of the

personality disorders could not be computed to our

model. Regarding the comparison of those groups, one

can note that, apart the item “drinking for searching so-

cial contact”, all the variables are significantly different

between the persons with an alcohol dependence and the

alcohol users whose the mean of the disturbance of the

alcoholic behaviours is higher than 24. This suggests a

problem with alcohol drinking (alcohol abuse) among

this sample. If we focus on the results for pharmaco-

dependence (48.33 versus 0.44), it is clearly higher among

the alcohol-dependent persons than among the alcohol

abusers, that confirms what we expected.

If we follow the step by step regression method from

the score of pharmaco-dependency, one can see that the

level of the disturbance of the alcoholic behaviour is at

first implied in the two groups, then if we continue, one

can see that “drinking for sensation seeking” is implied

in the score of pharmaco-dependency. Eliminating this

variable leads us to a non-significant result for the both

groups. Then, if we study the “disturbance of the alco-

holic behaviour”, three variables are implied in the

groups: Sensation seeking and anxious and depressive

features. The “sensation seeking” is explained by anxious

features which are themselves influenced by the depress-

sive features. The study of the depressive features leads

to an effect of “drinking because of psychological prob-

lems” that is explained first by the “disturbance of the

alcoholic behaviour” and secondly by the “pharmaco-

dependence”.

Thus, we arrive at the following model (Schema 1)

which provides for the two groups the conditions of the

validity of a structural equation model: non-significant χ2,

GFI and CFI closed to 1, RMSEA closed to 0.

Table 1. Global outcomes of this study.

People with alcohol dependency Alcohol users

Pelc’s questionnaire

Disturbance of the alcoholic behaviour 70.13 35.65

Consumption of alcohol searching for social contactsb 49.20 42.46

Drinking alcohol for it taste 54.25 39.67

Drinking alcohol because of psychological difficulties 57.55 18.37

Drinking alcohol for sensation seeking 43.25 12.44

Drinking alcohol because of pharmaco-dependency 48.33 0.44

SCL 90r

GSI 1.31 0.59

PST 62.18 32.17

PSDIb 1.83 1.58

Somatisation 14.80 6.67

Obsession 15.13 6.77

Sensitivity 11.78 6.15

Depression 17.90 8.83

Anxiety 12.78 5.02

Hostility 7.20 3.25

Phobia 7.73 2.25

Paranoia 8.30 4.37

Psychosis 11.63 4.02

Non specific 11.50 6.44

Dysfonction Attitude Scalea 142.00 75.00

N 40 52

aAbnormal distribution (Z by Kolmogorov-Smirnof); bNon-signiticant differences (p > 0.05).

S. Combaluzier / Open Journal of Psychiatry 2 (2012) 317-320 319

Disturbance of

the alcoholic

ehavio u

Alcohol drinking

because of sensation

seeking

Alcohol drinking

because of

psychological

problems

Depressive features Anxious features

Pharmaco-dependency

Schema 1. Model of the intensity of pharmacodependency

among persons with alcohol abusing or dependency disorders.

Alcohol dependent: x2 = 4.8, df = 6, p = 0.565, GFI = 0.961,

CFI = 1, RMSEA = 0; Alcohol abusers: x2 = 6.85, df = 7, p =

0.335, GFI = 0.957, CFI = 0.995, RMSEA = 0.053.

Also we can argue that to differentiate abusers of al-

cohol and dependent persons the intensity of the vari-

ables is more important than their combinations. But if

the differences between alcohol using and dependency

are a matter of intensity how one can explain that the

abusing turns to dependency?

According to our outcomes, the sequence “pharmaco-

dependence”, “drinking alcohol because of psychological

problems”, “depressive features” and “disturbance of the

alcoholic behaviour” is a retroaction that may explain the

shift from a mean score of 0.44 among heavy drinkers in

a score of 48.33 recorded in alcohol-dependent individu-

als (cf. Ta b l e 1 ). Another retroaction can be drawn that

implies “anxious features” and “sensation seeking” that

also can increase the pharmaco-dependence.

4. DISCUSSION

This model needs to be validated against other data with

larger groups or other questionnaires. Therefore, if we

test it with the data of the two groups that we left be-

cause of the initial randomization, the criteria of validity

are still significant.

According to the model, there is a transition from al-

cohol abuse to alcohol dependency, or in other words,

dependency is a form of alcohol abusing that does not

need more variables, or factors, to explain.

If we focus on the relationships between alcoholic be-

haviours and depressive features the feed-back in this

model lets us answer to the question of the primary or

secondary depressive syndromes among alcoholic people.

Depression is primary to disturbance of alcoholic beha-

viours and has direct and indirect (mediated by anxiety

and sensation seeking) to the disturbance of the alcoholic

behaviour; on the other hand, through the mediation of

the drinking because of psychological problems, the de-

pressives features are induced by the alcoholic beha-

viours and appear as secondary to alcohol related prob-

lems. Therefore, the depressive features are not the cen-

tral basis of this model. If we control their intensity by

using the partial correlation method, the correlations im-

plied in this model keep their significance.

The model that can be constructed from our data leads

us to the conclusion that the intensity of pharmaco-depen-

dence depends on the intensity of two main variables:

level of the disturbance of alcohol relationship and con-

sumption of alcohol for sensation seeking. The feed-

back from the “disturbance of the alcohol relationship”

to depressive features (mediated by the consumption of

alcohol because of psychological problems) that involves

the disturbance of the alcoholic behaviour directly and

indirectly contributes to increasing pharmaco-depen-

dence.

But how does alcohol abuse turn to dependence? This

model let us understand the transition from an abusing

drinking (m = 35.65) to a dependent consumption of al-

cohol (n = 70.32) thanks to the indirect incidence of the

“alcohol drinking because of psychological problems” on

the pharmaco-dependence (0.44 among the groups of

alcohol users against 48.3 in the alcohol dependent group)

and the retroaction of pharmaco-dependence on “alcohol

drinking because of psychological problems”.

Finally, the data confirm the incidence of the distur-

bance of the alcoholic behaviour on the alcohol-depen-

dency. If we focus on the persons whose score of alcohol

problems is higher than 24, our model becomes non-

significant. Therefore the size of this sample (n = 21)

does not allow us to get further. Also it would be inter-

esting to look for the critical point where disturbance of

the alcoholic behaviour turns a “normal drinking” into

dependant alcoholism.

Other works especially using specific questionnaires

for each factor should confirm this study. Such a data

collect would let us re-test the validity of this integrative

model which deals with both majors forms of alcoholic

disorder: abusing and dependency.

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