Abstract
ObjectivesTo investigate the psychometric properties of the frequently used Alcohol Dependence Scale (ADS) in older adults and the associations between ADS scores and alcohol use and DSM‐5 AUD symptom counts.MethodsUsing baseline data from an international multicenter RCT on outpatient AUD treatment for adults aged 60+ with DSM‐5 alcohol use disorder (AUD; n = 529), we computed Cronbach's alpha (α) and applied confirmatory (CFA) and exploratory factor analysis (EFA) to determine the underlying factor structure. A structural equation model (SEM) explored the interrelationship of latent ADS factors with alcohol use and number of DSM‐5 criteria endorsed.ResultsInternal consistency of the ADS (α = 0.81) was good. EFA revealed a three‐factor structure. Factor 1 (“Severe withdrawal symptoms”) consisted of severe psychoperceptual and psychophysical consequences of excessive drinking, Factor 2 (“Loss of control”) consisted of acute physical reactions of intoxication, and Factor 3 (“Obsessive–compulsive drinking”) described habitual drinking. The SEM suggested that only Factor 3 had large effects on DSM‐5 symptom score and drinking behavior.ConclusionLowering the ADS threshold or focusing on ADS items from Factor 3 may be more suitable measures of severity of alcohol dependence in treatment‐seeking older adults as ADS scores are low and not closely related to DSM‐5 AUD.
Highlights
We have found that the Alcohol Dependence Scale (ADS) is moderately suitable to measure the severity of alcohol dependence in treatment-seeking older adults as the overall score is low and not overall closely related to DSM-5 alcohol use disorder (AUD) symptom counts and drinking measures
In older outpatients with DSM-5 AUD, ADS items related to obsessivecompulsive drinking are most in agreement with currently applied DSM-5 AUD and drinking measures and may be singled out for diagnostic application as the most feasible indicator of DSM-5 AUD severity in this population
A recommendation would be to lower ADS thresholds for levels of alcohol dependence severity based on the ADS for older adults
Summary
The prevalence rates for AUD and problematic alcohol consumption (e.g., binging) have increased among older adults (Bjørk, Vinther-Larsen, Thygesen, Johansen, & Grønbæk, 2006; Han, Moore, Sherman, Keyes, & Palamar, 2017; Piontek, Gomes de Matos, Atzendorf, & Kraus, 2017). Substantial rates of problematic alcohol use and indication of AUD, by means of screening questionnaires among older adults, have been found in a variety of epidemiological studies from different western countries L. Chou, Mackenzie, Liang, & Sareen, 2011; Geels et al, 2013; Grant et al, 2015; Han et al, 2017; Hapke, v der Lippe, & Gaertner, 2013; Piontek, Gomes de Matos, Atzendorf, & Kraus, 2016)
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