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Addictive Behaviors 28 (2003) 347 – 352

Nondaily drinkers score higher on the Alcohol Dependence Scale than daily drinkers
Linda D. Wooda, Linda C. Sobella,*, Mark B. Sobella, Liane Dornheima, Sangeeta Agrawalb
Center for Psychological Studies, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314, USA b University of Nebraska, Medical Centre College of Nursing, 985330 Nebraska Medical Centre, 68199-5330, Omaha, NE, USA

Abstract To evaluate the relationship between drinking pattern and alcohol dependence severity, 209 individuals voluntarily seeking treatment for alcohol problems were administered the Alcohol Dependence Scale (ADS), the Short Alcohol Dependence Data (SADD) questionnaire, and a 12month Timeline Follow-Back (TLFB) drinking assessment as part of their pretreatment assessment. Based on their TLFB data, participants were divided into two groups: daily (DD, n=84) and nondaily (NDD, n=125) drinkers. The two groups were compared on several demographic and drinking variables. It was hypothesized that DD would have higher scores on measures of alcohol dependence than NDD. However, the reverse pattern was found. The NDD had significantly higher ADS scores than the DD. An analysis of ADS subscale scores indicated that the primary difference between the two groups was in the domain of loss of behavior control. It is suggested that NDD may perceive intoxication as more impairing, perhaps because they have acquired less tolerance than DD. These results suggest that treatment focused on restoring a sense of behavior control would be beneficial for NDD. D 2002 Elsevier Science Ltd. All rights reserved.
Keywords: Alcohol; Drinking; Dependence

* Corresponding author. Tel.: +1-954-262-5811; fax: +1-954-262-3895. E-mail address: (L.C. Sobell). 0306-4603/02/$ – see front matter D 2002 Elsevier Science Ltd. All rights reserved. PII: S 0 3 0 6 - 4 6 0 3 ( 0 1 ) 0 0 2 2 4 - 6

D. 1983). The study was approved by a joint Addiction Research Foundation and University of Toronto Ethics Committee. the Alcohol Dependence Scale (ADS. (5) no current psychological or substance abuse treatment. 1993. / Addictive Behaviors 28 (2003) 347–352 1. (3) not legally coerced. because daily consumption of large amounts of alcohol is necessary to manifest physical withdrawal symptoms upon stopping drinking. Raistrick et al. (7) zero blood alcohol level at the assessment. 1983). Participants The participants were 209 alcohol abusers who volunteered to participate in a treatment study at an outpatient addiction treatment program in Toronto. The present study was designed to test this prediction by comparing alcohol abusers’ pretreatment ADS and SADD scores to their reports of drinking for the year prior to treatment gathered by the Timeline Follow-Back (TLFB. nonalcoholic). Wood et al. 1993.348 L. Aasland. and (9) provided the name of a collateral informant who could verify their posttreatment self-reports. 1992).. The Short Alcohol Dependence Data (SADD) questionnaire is a similar scale that also has a good psychometric profile (Allen & Columbus. Skinner & Allen. 1995). seizures. Sobell. 1983. & Hodgson. One reason was to reconceptualize the severity of alcohol problems as lying on a continuum rather than dichotomously classifying individuals as having problems (i. delirium tremens). Saunders. . Method 2.e.. Participants were part of a randomized clinical trial evaluating individual versus group format Guided Self-Change treatment (Sobell & Sobell. To qualify for the study. 1976) was formulated for several reasons (Edwards. hallucinations. For example. in a clinical population one would expect frequency of drinking to be positively correlated with dependence severity.e. (6) no past history of major alcohol withdrawal symptoms (i. & Davidson. (8) signed an informed consent. Because the ‘‘syndrome’’ involves several dimensions of symptoms with individuals not having to experience all of the symptoms to qualify for a diagnosis of dependence. (4) volunteered to participate in a study of brief self-change treatment.g. This syndrome concept evolved to become the basis for the diagnosis of alcohol dependence in the Diagnostic and Statistical Manual — IV (DSM-IV. Sobell & Sobell. 1995). Stockwell. Sobell. Dunbar. Canada. Raistrick. 1994). (2) 18 years of age.. De La Fuente. concurrent validity). & Grant. alcoholic) or not having problems (i. American Psychiatric Association. participants had to have a low to moderate score on the ADS (score 25). Murphy. 1998. 1986). 1982). Other inclusion criteria were: (1) primary alcohol problem. Introduction The concept of an alcohol dependence syndrome (Edwards & Gross. One such scale.e. Babor..1.e. 1995. That is.. & Cleland. Scales developed to assess the alcohol dependence syndrome would be expected to correlate with features of behavior postulated by the syndrome concept (i. more frequent drinkers would be expected to be more severely dependent.. several scales have been developed to measure alcohol dependence severity (e. Brown. 2. 1995. has been found to have strong psychometric characteristics (Allen & Columbus.

The SADD questionnaire contains 15 items with a maximum score of 45. 1984). alcohol-free.47)] and the ADS [DD mean .0% were married.D.) age was 41.)=12. and Obsessive Drinking Style (Skinner & Allen. described above. their mean (S. They reported drinking heavily for a mean (S. n=125) were defined as those who drank <312 days in the 12 months pretreatment. n=84) were defined as those who drank 312 days (i. their mean (S. considerable evidence suggests that TLFB reports are generally reliable and relatively valid when gathered under certain conditions (i. P > .7 (3.D. & Cancilla.8) years. The SADD was derived from the 34-item Alcohol Dependence Data (ADD) questionnaire (Raistrick et al. and high levels of alcohol dependence.9 (8. 1992.6) years.e.) reported number of drinks per drinking day did not differ significantly [DD=6. Leo.12).. did not support this hypothesis. Although the groups differed in frequency of drinking by virtue of their group assignment. confidentiality assured. 1988).08 (5. their mean (S. voluntary. 1995.) of 10. 6 days per week on average) in the 12 months pretreatment.e. Psychophysical Withdrawal.7 (10. According to Skinner and Allen (1982). and their mean (S. Daily drinkers (DD. 1983)..D.2% were married.3%) of the DD group were male.5) years.8 (2. were also nonsignificant ( P>. Sobell.8 (8. The results.) education level was 14. Skinner & Horn.D. & Sobell.D. 2.. Wood et al.) age was 45. 2000.D. The TLFB is a well-established method for obtaining retrospective self-reports of drinking (Allen & Columbus.D.4). 1982. correspond to low. Toneatto.)=13.6%) of the NDD group were male. Slightly more than two-thirds (70. respectively (Raistrick et al.05]. 14–21 an intermediate level (second quartile).0 (2.0 (11.2) years. Instruments The revised 25-item ADS contains 25 items and has a maximum score of 47 with four subscales: Loss of Behavior Control.) of 10.8) years. NDD mean (S. and their mean (S.15 (5. a score of 1–13 represents a low level of alcohol dependence (first quartile). the 209 participants were assigned to either of two groups based on their TLFB reports of drinking for the 1 year prior to treatment. Sobell & Sobell.. 1994). 72. 22–30 a substantial level (third quartile). Group differences on the other demographic and drinking history variables. Nondaily drinkers (NDD. and 20–45.5) years. / Addictive Behaviors 28 (2003) 347–352 349 For this study.1).D. Psychoperceptual Withdrawal. & Marlatt. Although retrospective reports are subject to errors of memory and distortion.D.05). 1987. and 31–47 a severe level (fourth quartile). 73. Sobell. Babor.2. Results It was predicted that the DD would be more dependent on alcohol than the NDD and thus would score higher on the ADS and the SADD.8% were employed. It has been suggested that SADD scores of 1–9. American Psychiatric Association. 56.L. 3. in a clinical or research setting.2 (3. 59. 1983). Sobell.8% were employed. They reported drinking heavily for a mean (S. however. The NDD group scored higher than the DD group on both the SADD [DD mean (S. medium.) education level was 14. NDD=6. 10–19. Two-thirds (64. Stephens.D.

DD may not perceive such a lack of control perhaps because they have less of a contrast between drinking and nondrinking days. Wood et al. the two groups of participants’ scores on the ADS subscales were analyzed using independent sample t tests.001 ns ns ns (S. George.013 for Type 1 error was used to evaluate the test findings.D. 1989). Because four tests were conducted a Bonferroni-adjusted significance level of .03 (1. indicate that the group difference on the ADS derived primarily from the Loss of Behavior Control subscale.)=11. These results. that NDD have developed less tolerance to alcohol and that therefore they subjectively perceive themselves as more intoxicated.02 0. Although the difference between ADS scores for the DD and NDD groups were statistically significant ( P<. It was found that NDD scored significantly higher than DD on the ADS. et al.)=13. for the item that reads ‘‘How much did you drink the last time you drank?’’ (response options were: ‘‘enough to get high or less’’.5% of the DD participants endorsed ‘‘enough to get drunk’’ compared to 42.87 1. In an effort to understand these results.45) (0.001). 15.97) NDD 6.61) (1. Because the groups’ reports of number of years of heavy drinking and their reported number of drinks consumed per drinking day did not differ significantly. One possible explanation for the present finding.91).09) P value <.85 1. is that NDD perceive themselves to have a greater degree of loss of control of their behavior due to the less consistent pattern of their drinking.079).32 1.30 1. 3.D. For example. 4. Another alternative explanation for the findings involves drinking restraint theory (Collins. however.37)]..11 (1.83 (5.8% of the NDD participants.95) (0. ‘‘enough to pass out’’).) DD 5. / Addictive Behaviors 28 (2003) 347–352 Table 1 Subscale analysis for the ADS comparing DD (n=84) with NDD (n=125) ADS subscale Loss of Behavior Control Psychoperceptual Withdrawal Psychophysical Withdrawal Obsessive Drinking Style Group mean (S.02 2. it does not appear that NDD drank more than the DD on days when they did drink.96) (0. displayed in Table 1.00 (4.350 L.48) (1. The NDD may have drank less frequently than the DD because they . the DD participants endorsed ‘‘enough to get high or less’’ 81% of the time compared to 48.8% for the NDD participants. Discussion The results of this study were contrary to the hypothesis that DD as opposed to NDD would score higher on measures of alcohol dependence severity. the difference between their SADD scores only approached significance ( P=.79) (1. suggested by the ADS subscale analysis.6% of the DD participants endorsed ‘‘enough to pass out’’ compared with 8.D. and although the difference between groups was not significant for the SADD questionnaire the pattern of scores was consistent with that found for the ADS. ‘‘enough to get drunk’’. NDD mean (S.4% of the NDD participants.D. It is possible.

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