Cognitive dysfunction in the prediction of relapse in alcoholics.

CUMULATING EVIDENCE (e.g., 1) has undermined the widespread belief that alcoholism is a unitary phenomenon. Associated with this new evidence is the realization that the attempt to find the alcoholic personality or the essential psychological or physical precursor of alcoholism is an exercise in futility. A major consequence of viewing alcoholism as a unitary disorder has been that population diversity has not been taken into account in the design and evaluation of treatment programs (2) even though it has been demonstrated repeatedly that hospitalized alcoholics are a heterogeneous group (3) and that a number of the intragroup differences have implications for treatment outcome (4). Investigators who have focused on patient variables in relation to treatment outcome have not attempted to determine the relative importance of these factors. Consequently, the major dimensions of patients that must be matched or statistically controlled in treatment evaluation remain obscure, and differences in treatment outcome from one program to another are confounded to an unknown degree by differences in patients' characteristics. Additionally, lack of knowledge as to the measures most closely related to relapse has hindered the development of treatment methods optimally tailored to individuals or clinical subgroups of patients. A large body of literature (e.g., 5, 6) documents the association between long-term heavy drinking and the deterioration and atrophy of brain tissue. This organic deterioration is, in turn, reflected in