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Lifetime Drinking History (LDH)

User Information

Acronym:

LDH

Author/Developer / Address:

Harvey A. Skinner, Ph.D.
Professor and Chair
Department of Public Health Sciences
Faculty of Medicine.
University of Toronto.
12 Queen's Park Cres.
West, Toronto.
Ontario.
Canada, M5S, 1A8.
Phone: (416) 978-8989.Fax: (416) 978-2087.
E-mail: harvey.skinner@utoronto.ca

Publication dates:

1979

Description / Type of Assessment:

LDH is a structured interview where the client is asked about patterns of alcohol consumption from the first year of regular drinking to the present.

Primary use / Purpose:

LDH is designed to provide quantitative indices of an individual's alcohol consumption patterns from the onset of regular drinking.

Domains measured / Life Areas / Problems Assessed:

In addiction to actual consumption levels (quantity), attention is focused upon the frequency of use, variability in consumption, types of beverages, life events that mark a change in drinking pattern, solitary versus social drinking, and time of the day where the alcohol is consumed.

Population:

Adults and adolescents, both normal drinkers and clinical populations.

Administration / Completion Time:

20 minutes.

Scoring Procedures:

Scored by hand or calculator.

Scoring Time:

5-10 minutes.

Credentials/Training:

Training required for administration.

Source of Psychometrics:

Harvey A. Skinner, Ph.D.
(See address above).
Reliability studies made: Test-Retest.
Measures of validity derived: Content and Construct.

Languages:

English

Availability / Inquiries:

Harvey A. Skinner, Ph.D. (See address above).

Price:

Cost nominal (copyright costs).

Practicability / usefulness:

LDH is valuable as a part of the intake assessment to give an overview of the client's drinking career patterns and life event changes. The process of completing the history is often instructive for clients. The LDH is also valuable in treatment evaluation research where a comprehensive drinking history is desired. Also in epidemiological research, e.g., comparing alcohol history with morbidity patterns.

Comments:

LDH is useful for the above-mentioned purposes, but lacks precision for the most recent drinking periods.

Relevant Studies
Reliability of Alcohol Use Indices.
Skinner, H.A., Wen-Jenn Sheu. Reliability of Alcohol Use Indices. The Lifetime Drinking History and the MAST. Journal of Studies on Alcohol, 43, 11, 1157-1170, 1982

Reliability estimates for internal consistency and for test-retest values are presented for various indices of the Lifetime Drinking History. Reliability estimates were obtained under conditions that closely resemble a typical clinical setting, not in optimal conditions to obtain the highest estimates.

In the LDH, aggregate indices for total lifetime drinking can be assessed with moderate to fairly high reliability. For epidemiological research into relationships between alcohol consumption and morbidity patterns, lifetime duration of drinking (.94), total volume (.80) corrected for body weight, and daily average (.68) should prove to be valuable tools. Furthermore, this structured interview typically provides important clinical background information about factors associated with major shifts in drinking patterns and, so, could be helpful in treatment.

Reliability estimates for the drinking phase just prior to entering treatment, on the other hand, are only moderate for the LDH. One reason is that subjects were required at the retest session to reconstruct their drinking patterns at the pretreatment phase an average of 4.8 months previous. Moreover, many subjects in this study had a long history of excessive alcohol consumption which could have resulted in memory deficits. Another factor might be the atypical nature of drinking patterns just prior to an individual's seeking treatment for alcohol misuse.

Instruments for Assessing Alcohol and Drug Problems.
Skinner, H.A.  Instruments for Assessing Alcohol and Drug Problems. Bulletin of the Society of Psychologist in Addictive Behaviors, 3, 21-33, 1984. The Lifetime Drinking History traces major phases in an individual?s drinking career from the onset of regular drinking.

Skinner and Sheu examined factors that influence test-retest reliability of the Lifetime Drinking History and the widely used Michigan Alcoholism Screening Test or MAST (Selzer, 1971). The sample consisted of 83 individuals who were initially assessed upon entry to treatment and then reassessed an average of 4.8 months later. The concurrent validity of the Lifetime Drinking History was investigated with a large sample (n = 310) of individuals presenting for help for their alcohol problems at the Clinical Institute of the Addiction Research Foundation. Selected indices from the lifetime and present drinking phase were correlated with two widely used instruments for the assessment of alcoholism: the Michigan Alcoholism Screening Test (MAST) and the Alcohol Use Inventory (AUI). The MAST was found in this clinical population to provide a highly reliable index of the range of consequences related to alcohol misuse (Skinner, 1979a). Moderately positive correlations with the MAST were evident with all of the drinking indices, with the Lifetime Daily Average having the highest correlation (r = .50). A similar pattern of correlations was observed with the AUI, especially those scales that tap more severe levels of alcohol dependence. In general, the drinking history indices are more highly correlated with an obsessive-compulsive drinking style, social and work related problems, and alcohol-withdrawal symptoms. Thus, the pattern of correlations with the MAST and AUI indicates that a history of excessive alcohol consumption is significantly related to psychosocial and physical disorders.

An important aspect of validating the Lifetime Drinking History is to compare alcohol consumption indices with laboratory tests that are known to be influenced by drinking (Holt, Skinner & Israel, 1981). The liver enzyme gamma-glutamyl-transpepidase (gamma-GT) hold promise as an objective indicator of excessive drinking. Two other promising biochemical markers include mean corpuscular volume (MCV) and high density lipoprotein (HDL). With respect to lifetime indices, the most consistent relationships were gamma-GT. MCV was influenced mainly by the duration of drinking, whereas HDL was not correlated with any of the lifetime indices. However, HDL was correlated with the present frequency of drinking but not with the actual quantity consumed. Similarly both gamma-GT and MCV were related to the present frequency of drinking.

Another study focussed on identifying relatively distinct patterns of alcohol consumption assessed by the Lifetime Drinking History. Skinner and Sheu looked at the first four phases from the start of regular drinking in a large sample of individuals with alcohol-related problems. Four distinct patterns of alcohol consumption frequency and quantity were identified and replicated using a cluster analytic procedure (Skinner, 1979b). Each pattern may be used to characterize the drinking history of a specific subset of individuals. Pattern I is marked by an initially high frequency of drinking that drops to lower frequency over the next two phases and then rises again during the fourth phase. The actual quantity of alcohol consumed per session remains below average until an upsurge at the fourth phase. In contrast. Pattern II is characterized by a rapid increase in drinking frequency compared with a more gradual rise in quantity consumed over the first four phases. Pattern III begins with low frequency but high quantity consumed on drinking occasions . Over the next three phases, there is a parallel increase in both frequency and quantity consumed. Finally. Pattern IV has a negative serial correlation between each phase. That is, a relatively high frequency and quantity at one phase lead to a marked decrease in drinking at the subsequent phase, and viceversa.

Given the four drinking patterns the next step was to determine whether certain patterns were more predictive of the development of alcohol abuse. Pattern III (very high quantity, increasing frequency) individuals were found to have the greatest symptoms of alcohol dependence and these individuals reported problems with controlling alcohol intake. This finding suggests that individuals who begin to drink fairly large quantities per session (irrespective of the frequency of drinking) are more likely to develop symptoms of alcohol dependence. In contrast, Pattern II (high frequency, low quantity) individuals tended to develop consequences related to alcohol misuse but they did not exhibit symptoms of alcohol dependence. With Pattern II individuals, alcohol abuse tends to be a function of drinking frequency rather than the quantity consumed. In summary, aggregate indices for total lifetime drinking can be assessed with moderate to fairly high reliability. For epidemiological research into relationships between alcohol consumption and morbidity patterns, the Lifetime Drinking History should prove to be a valuable tool. Furthermore, this structured interview typically provides important clinical information about factors associated with major shifts in drinking patterns and, so, could be helpful in assessment for treatment.

The LDH has excellent psychometric properties, and may be used as both research and clinical diagnostic tool.

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Page last updated: Wednesday, 14 July 2004