Open Journal of Psychiatry, 2012, 2, 317-320 OJPsych Published Online October 2012 (
Toward an integrative model for alcohol use and
Serge Combaluzier
Department of Psychology, University of Rouen, Rouen, France
Received 21 July 2012; revised 25 August 2012; accepted 5 September 2012
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
Keywords: Structural Equation Modelling; Alcohol
Abuse; Alcohol Dependence
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
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.
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.
S. Combaluzier / Open Journal of Psychiatry 2 (2012) 317-320
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.
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-
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).
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S. Combaluzier / Open Journal of Psychiatry 2 (2012) 317-320 319
Disturbance of
the alcoholic
ehavio u
Alcohol drinking
because of sensation
Alcohol drinking
because of
Depressive features Anxious features
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.
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-
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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