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Abstract
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AIMS: To formulate harmful-dysfunction (HD) diagnostic criteria for alcohol use disorder (AUD) and test whether they increase validity relative to standard DSM criteria, as evidenced by lowered prevalence, increased validator levels including service use, severity, and family history, and enhanced specificity.
DESIGN: DSM-IV AUD, DSM-IV dependence, DSM-5 AUD, and HD AUD definitions were compared on eight validity-related tests using nationally representative community data. SETTING: United States of America PARTICIPANTS: National Epidemiological Survey of Alcoholism and Related Conditions (NESARC) respondents, ages 18-54 (wave 1, N=29,673; wave 2, N=24,444). MEASURES: NESARC DSM-IV and DSM-5 criteria were taken from published studies. Whereas DSM-5 diagnosis requires any two AUD symptoms, HD criteria were constructed from NESARC items to require symptoms of both impaired-control dysfunction (withdrawal, drink to prevent/stop withdrawal, can't stop/reduce drinking, or craving [wave 2 only]) and harm (sacrificed important activities, problems caring for home/family, job/school problems, health problems, psychological problems, or problems with family/friends). Validators included service use, severity, and family history, among others. Specificity was tested using a teen-transient-drinker criterion group.
FINDINGS: Compared with DSM-5 AUD (DSM-IV results were similar), HD criteria yielded lower prevalence (95% CIs): HD lifetime 6.7% (6.2%, 7.2%), one-year 2.3% (2.0%, 2.5%); DSM-5 lifetime 38.2% (36.5%, 39.9%), one-year 13.2% (11.7%, 13.1%). HD AUD was higher than DSM-5 on pathology validators, including: lifetime alcohol-related service use: HD 41.0% (38.1%, 43.9%), DSM-5 11.5% (10.7%, 12.3%); severity (number of lifetime alcohol symptoms): HD 20.8 (20.4, 21.2), DSM-5 10.6 (10.4, 10.8); and family history of alcohol problems: HD 50.1% (47.3, 52.9), DSM-5 32.8% (31.6, 34.0). HD criteria eliminated 83% of a DSM-5 teen-transient-drinker false-positives criterion group.
CONCLUSIONS: Prevalence of a diagnosis of 'alcohol use disorder' appears to be lower when using 'harmful-dysfunction' diagnostic criteria than using standard DSM criteria, partly by reducing misdiagnosis of teenage transient drinkers. This article is protected by copyright. All rights reserved.
Language: en |