Comparison of DSM-IV and DSM-5 criteria for alcohol use disorders in VA primary care patients with frequent heavy drinking enrolled in a trial

Traci Takahashi,Amy K Lee,Gwen Lapham,Diane Greenberg,Anna Rubinsky,Joseph O Merrill,Julie E Richards,Douglas Berger,Katharine A Bradley,Laura J Chavez,Emily C Williams,Eric J Hawkins

doi:10.1186/s13722-017-0082-0

Abstract

BackgroundCriteria for alcohol use disorders (AUD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) were intended to result in a similar prevalence of AUD as DSM-IV. We evaluated the prevalence of AUD using DSM-5 and DSM-IV criteria, and compared characteristics of patients who met criteria for: neither DSM-5 nor DSM-IV AUD, DSM-5 alone, DSM-IV alone, or both, among Veterans Administration (VA) outpatients in the Considering Healthier drinking Options In primary CarE (CHOICE) trial.MethodsVA primary care patients who reported frequent heavy drinking and enrolled in the CHOICE trial were interviewed at baseline using the DSM-IV Mini International Neuropsychiatric Interview for AUD, as well as questions about socio-demographics, mental health, alcohol craving, and substance use. We compared characteristics across 4 mutually exclusive groups based on DSM-5 and DSM-IV criteria.ResultsOf 304 participants, 13.8% met criteria for neither DSM-5 nor DSM-IV AUD; 12.8% met criteria for DSM-5 alone, and 73.0% met criteria for both DSM-IV and DSM-5. Only 1 patient (0.3%) met criteria for DSM-IV AUD alone. Patients meeting both DSM-5 and DSM-IV criteria had more negative drinking consequences, mental health symptoms and self-reported readiness to change compared with those meeting DSM-5 criteria alone or neither DSM-5 nor DSM-IV criteria.ConclusionsIn this sample of primary care patients with frequent heavy drinking, DSM-5 identified 13% more patients with AUD than DSM-IV. This group had a lower mental health symptom burden and less self-reported readiness to change compared to those meeting criteria for both DSM-IV and DSM-5 AUD.Trial Registration ClinicalTrials.gov NCT01400581. 2011 February 17

Highlights

Criteria for alcohol use disorders (AUD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) were intended to result in a similar prevalence of AUD as DSM-IV
DSM-5 further specifies AUD severity as mild, moderate or severe based on the number of diagnostic criteria endorsed, with at least 2 of 11 criteria required for a diagnosis
Eligible and referred patients were contacted by telephone and determined to be eligible if they reported drinking at levels that exceeded National Institute on Alcohol Abuse and Alcoholism (NIAAA) daily drinking limits on a phone screen—4 drinks or 5 drinks, hereafter “binge”—at least twice a week on average, or once a week on average if they reported they had ever been in alcohol treatment or attended Alcoholics Anonymous [16]

Summary

Introduction

Criteria for alcohol use disorders (AUD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) were intended to result in a similar prevalence of AUD as DSM-IV. Diagnostic orphans have an increased risk of developing a DSM-IV alcohol use disorder compared to those with no AUD symptoms in certain populations [e.g. young adults] and are an important group to identify [10]. Those who had DSM-IV abuse based on 1 criterion will not meet criteria for DSM-5 AUD [11]. The design of the DSM-5 AUD criteria is such that all people who met criteria for DSM-IV dependence but only some people with DSM-IV abuse will have an AUD based on DSM-5 criteria, while additional patients with only 2 symptoms of dependence will meet criteria

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