DSM-5 Alcohol Use Disorder Research Articles

Reliability and validity of the Brief DSM-5 Alcohol Use Disorder Diagnostic Assessment: A systematic replication in a crowdsourced sample

Effectively and efficiently identifying alcohol use disorder (AUD) is an essential goal for researchers and clinicians alike. To date, there are a limited number of self-reported tools specifically designed for evaluating DSM-5 criteria for AUD. The Brief DSM-5 AUD Diagnostic Assessment is a recently created participant self-reported measure with demonstrated reliability and validity in college student populations. The purpose of this study was to replicate and extend these findings by evaluating the psychometric properties of the Brief DSM-5 AUD Diagnostic Assessment in a geographically diverse adult sample with varying alcohol use history. Participants (N = 1986) were sampled from the crowdsourcing website Amazon Mechanical Turk (mTurk). The Brief DSM-5 AUD Diagnostic Assessment was completed to evaluate scale reliability and validity. A subset of individuals with answers indicative of AUD (N = 448) also completed a battery of standardized alcohol use questionnaires for additional validity assessments. High internal consistency reliability was observed (α = 0.92) along with strong item-total correlations. Convergent validity was supported by significant positive relationships between diagnostic category and measures of alcohol use consumption and severity. Modest relationships that were generally not statistically significant were observed with soda use measures supporting discriminant validity. AUD severity remained a significant predictor of alcohol use measures after accounting for AUDIT scores, thereby establishing incremental validity. These findings collectively support the Brief DSM-5 AUD Diagnostic Assessment as a reliable, valid, and rapid self-report tool for evaluating DSM-5 AUD in diverse research and clinical settings.

DSM-5 alcohol use disorder features among treatment-seeking older adults

Abstract. Background: The number of older adults with alcohol use disorder (AUD) is expected to rise. Adapted treatments for this group are lacking and information on AUD features in treatment seeking older adults is scarce. The international multicenter randomized-controlled clinical trial “ELDERLY-Study” with few exclusion criteria was conducted to investigate two outpatient AUD-treatments for adults aged 60+ with DSM-5 AUD. Aims: To add to 1) basic methodological information on the ELDERLY-Study by providing information on AUD features in ELDERLY-participants taking into account country and gender, and 2) knowledge on AUD features in older adults seeking outpatient treatment. Methods: baseline data from the German and Danish ELDERLY-sites (n=544) were used. AUD diagnoses were obtained with the Mini International Neuropsychiatric Interview, alcohol use information with Form 90. Results: Lost control, desired control, mental/physical problem, and craving were the most prevalent (> 70 %) AUD-symptoms. 54.9 % reported severe DSM-5 AUD (moderate: 28.2 %, mild: 16.9 %). Mean daily alcohol use was 6.3 drinks at 12 grams ethanol each. 93.9 % reported binging. More intense alcohol use was associated with greater AUD-severity and male gender. Country effects showed for alcohol use and AUD-severity. Conclusion: European ELDERLY-participants presented typical dependence symptoms, a wide range of severity, and intense alcohol use. This may underline the clinical significance of AUD in treatment-seeking seniors.

A data-driven method for identifying shorter symptom criteria sets: the case for DSM-5 alcohol use disorder.

Although the DSM is a widely used diagnostic guide, lengthy criteria sets can be problematic and provide the primary motivation to identify short-forms. Using the 11 diagnostic criteria provided by the DSM-5 for alcohol use disorder (AUD), the present study develops a data-driven method to systematically identify subsets and associated cut-offs that yield diagnoses as similar as possible to use all 11 criteria. Relying on data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), our methodology identifies diagnostic short-forms for AUD by: (1) maximizing the association between the sum scores of all 11 criteria with newly constructed subscales from subsets of criteria; (2) optimizing the similarity of AUD prevalence between the current DSM-5 rule and newly constructed diagnostic short-forms; (3) maximizing sensitivity and specificity of the short-forms against the current DSM-5 rule; and (4) minimizing differences in the accuracy of the short-form across chosen covariates. Replication is shown using NESARC-Wave 2. More than 11 000 diagnostic short-forms for DSM-5 AUD can be created and our method narrows down the optimal choices to eight. Results found that 'Neglecting major roles' and 'Activities given up' could be dropped with practically no change in who is diagnosed (specificity = 100%, sensitivity ⩾ 99.6%) or the severity of those diagnosed (κ = 0.97). With a continuous improvement model adopted by the APA for DSM revisions, we offer a data-driven tool (a SAS Macro) that identifies diagnostic short-forms in a systematic and reproducible way to help advance potential improvements in future DSM revisions.

Change in DSM-5 Alcohol Use Disorder Criteria Count and Severity Level as a Treatment Outcome Indicator: Results from a Randomized Trial.

Most clinical trials evaluating treatments for alcohol use target individuals meeting diagnostic criteria for alcohol use disorder (AUD), but few address change in diagnostic status following treatment or as a potential outcome indicator. This study evaluated whether DSM-5 AUD total criteria count or severity category was sensitive to change over time and treatment effects. Data were drawn from a randomized clinical trial that evaluated the efficacy of computer-based cognitive behavioral therapy program (CBT4CBT) for AUD. Sixty-eight individuals were randomized to 1 of the 3 weekly outpatient treatments for an 8-week period: (i) treatment as usual (TAU), (ii) TAU+CBT4CBT, and (iii) CBT4CBT+brief monitoring. Structured clinical interviews were used to determine current (past 30days) AUD diagnosis at baseline, end-of-treatment, and 6months following end-of-treatment. Change in the total number of DSM criteria endorsed, as well as severity categories (mild, moderate, severe), was evaluated across time and by treatment condition. Generalized Poisson's linear mixed models revealed a significant reduction in the number of DSM criteria from baseline to treatment end point [time effect χ2 (1)=35.54, p<0.01], but no significant interactions between time and treatment condition. Fewer total criteria endorsed, as well as achieving at least a 2-level reduction in AUD severity category at end-of-treatment, were associated with better outcomes during follow-up. Chi-square results indicated a greater proportion of individuals assigned to TAU+CBT4CBT had at least a 2-level reduction in severity category compared to TAU, at trend-level significance [χ2 (2, 54)=5.13, p=0.07], consistent with primary alcohol use outcomes in the main trial. This is the first study to demonstrate change in DSM-5 AUD total criteria count, as well as severity category, in a randomized clinical trial. These findings offer support for their use as a potential clinically meaningful outcome indicator.

DSM-5 Alcohol Use Disorder Severity in Puerto Rico: Prevalence, Criteria Profile, and Correlates.

Our aim was to examine lifetime criteria profiles and correlates of severity (mild, moderate, severe) of DSM-5 alcohol use disorders (AUD) in Puerto Rico. Data are from a household random sample of individuals 18 to 64years of age in San Juan, Puerto Rico. The survey response rate was 83%. DSM-5 AUD was identified with the Spanish version of the World Health Organization's Composite International Diagnostic Interview. The analyses also identify correlates of each severity level using an ordered logistic regression model. The prevalence of lifetime DSM-5 AUD among men and women was 38 and 16%, respectively. Mild lifetime DSM-5 AUD was the most prevalent severity level among both men (18%) and women (9%). The most common criteria, independent of gender and severity level, were drinking larger quantities and for longer than planned (men range: 80 to 97%; women range: 78 to 91%) and hazardous use (men range: 56 to 91%; women range: 42 to 74%). Results from ordered logistic regression showed that the adjusted odds ratio for weekly drinking frequency, greater volume of alcohol consumed per drinking occasion, positive attitudes about drinking, drinking norms, and male gender invariantly increased risks across all DSM-5 AUD severity levels (mild, moderate, severe). Greater negative attitudes about drinking, low family cohesion, and Protestant religion were related to greater risks at higher AUD severity levels. AUD prevalence is high in San Juan, Puerto Rico. Prevalence rates for some criteria are equally high across severity levels and poorly differentiate between mild, moderate, or severe DSM-5 AUD. The sociodemographic and alcohol-related risks vary across DSM-5 severity levels.

Craving as a DSM-5 Symptom of Alcohol Use Disorder in Non-Treatment Seekers.

DSM-5 has added craving as a new criterion and changed the diagnostic structure of alcohol use disorder (AUD). Though craving has long been a target of intervention, less is known about the impact this addition will have on prevalence and factor structure of AUD, particularly in non-treatment seeker with alcohol problems. Non-treatment seeking individuals reporting alcohol-related problems (N = 296) completed a structured clinical interview and the Penn Alcohol Craving Scale (PACS). PACS scores greater than 20 were considered to meet diagnostic criteria for the alcohol craving symptom. This study examined DSM-IV to DSM-5 diagnostic conversion and conducted an exploratory factor analysis to test the factor structure of the DSM-5 symptoms, including craving. The mean PACS score was 13.1 and alcohol craving was strongly correlated with other measures of alcohol use. Using the proposed cut-off score of PACS > 20, 46 participants (16.2%) met criteria for alcohol craving. Craving loaded moderately (0.47) onto the retained DSM symptoms and produced a unidimensional factor structure. The majority of participants who met for a DSM-IV AUD also met for a DSM-5 AUD (98.8%). Craving prevalence using the PACS was relatively low compared to the remaining 10 DSM-5 symptoms, possibly due to the non-treatment seeking nature of the sample. Conversion of DSM-IV to DSM-5 in this sample led to a small increase in overall AUD prevalence. Craving loaded well onto a single factor structure for AUD.

Children exposed to alcohol-related problems and DSM-5 alcohol use disorder in San Juan, Puerto Rico

ABSTRACTThis article estimates the proportion of children (17 and younger) exposed to an adult with an alcohol problem or alcohol use disorder (AUD) in San Juan, Puerto Rico. Data are from a household random sample of 1,510 individuals 18–64 years of age. A total of 20.9% of children in sample households were exposed to an adult with an alcohol problem, and 5.7% were exposed to an adult with DSM-5 AUD. These considerable proportions suggest that alcohol treatment and family support programs should include help for adults in the family, and special support for exposed children in the household.

The concurrent validity of the Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse subscale in adolescent patients in an urban federally qualified health center

ABSTRACTBackground: The Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse subscale has been validated with high school students, adolescents with criminal justice involvement, and adolescent substance use treatment samples using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R and DSM-IV. This study examines the concurrent validity of the POSIT's standard 17-item substance use/abuse subscale and a revised, shorter 11-item version using DSM-5 substance use disorder diagnoses. Methods: Adolescents (N = 525; 93% African American, 55% female) 12–17 years of age awaiting primary care appointments at a Federally Qualified Health Center in Baltimore, Maryland completed the 17-item POSIT substance use/abuse subscale and items from a modified World Mental Health Composite International Diagnostic Interview corresponding to DSM-5 alcohol use disorder (AUD) and cannabis use disorder (CUD). Receiver operating characteristic curves, sensitivities, and specificities were examined with DSM-5 AUD, CUD, and a diagnosis of either or both disorders for the standard and revised subscales using risk cutoffs of either 1 or 2 POSIT “yes” responses. Results: For the 17-item subscale, sensitivities were generally high using either cutoff (range: 0.79–1.00), although a cutoff of 1 was superior (sensitivities were 1.00 for AUD, CUD, and for either disorder). Specificities were also high using either cutoff (range: 0.81–0.95) but were higher using a cutoff of 2. For the 11-item subscale, a cutoff of 1 yielded higher sensitivities than a cutoff of 2 (ranges for 1 and 2: 0.96–1.00 and 0.79–0.86, respectively). Specificities for this subscale were higher using a cutoff of 2 (ranges for 1 and 2: 0.82–0.89 and 0.89–0.96, respectively). Conclusions: Findings suggest that the POSIT's substance use/abuse subscale is a potentially useful tool for screening adolescents in primary care for AUD or CUD using a cutoff of 1 or 2. The briefer, revised subscale may be preferable to the standard subscale in busy pediatric practices.

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

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

Alcohol Use Patterns and DSM-5 Alcohol Use Disorder on Both Sides of the U.S.-Mexico Border.

Alcohol consumption patterns on the U.S.-Mexico border and their relationships with DSM-5 alcohol use disorders (AUD) have been understudied. Yet, the effects of drinking by Mexican-origin individuals may differ between cities on versus off the border both in the United States and in Mexico. We characterize prior 12-month drinking patterns and examine their relationships with AUD, in border and off-border cities of Texas and adjacent Mexican states. Data come from the U.S.-Mexico Study of Alcohol and Related Conditions involving 2,336 Mexican Americans in Texas and 2,460 Mexicans in bordering states of Nuevo Leon and Tamaulipas in Mexico. Drinking pattern was defined as an interaction between volume and maximum amount, or intensity (never vs. ever 5+/4+ [men/women], 8+, and 12+ drinks in a day). DSM-5 AUD was assessed using an adaptation of the Alcohol Sectionof the World Health Organization Composite International Diagnostic Interview core. Separately by gender, 5 logistic regressions models controlling for age were estimated predicting symptoms in 2 or more AUD criteria domains from volume, heavy pattern and, successively, effects of country, and (by country) residing on vs. off the border, or in each of 3cities/country. A segmentation analysis for Texas males based on rate of experiencing AUD generated several distinct volume groups, each partitioned by an empirically selected maximum, and helped identify a drinking-pattern typology. In gender-stratified models of AUD rates using this typology, adjusting for age, significant volume and intensity effects were seen, more strongly in the United States. Border versus interior differences implied more AUD for given patterns at the border in the United States and the reverse in Mexico, with some city differences also evident. Drinking-pattern analyses confirm that border proximity may affect drinking problems but in opposite directions in the United States and Mexico, possibly related to economic and psychological stresses specific to respective communities.

Agreement between DSM-IV and DSM-5 criteria for alcohol use disorder among outpatients suffering from depressive and anxiety disorders.

Since significant differences have been reported, we estimated agreement between DSM-5 and DSM-IV criteria for alcohol use disorder (AUD). We assessed 327 outpatients (mean age: 45.2 ± 13.4) with depressive or anxiety disorders. Absolute differences in prevalence rates between DSM-5 and DSM-IV AUD ranged from -1.1% (subjects with anxiety disorders) to +1.8% (tobacco smokers). The agreement was excellent (k = 0.88), also accounting for specific subgroups (relevant k coefficients >0.80). DSM-5 criteria did not inflate AUD rates. Our results have epidemiological significance since, unlike previous reports, we found diagnostic stability between new and old AUD criteria in this clinical population. (Am J Addict 2017;26:53-56).

Family cohesion and pride, drinking and alcohol use disorder in Puerto Rico

ABSTRACTBackground: The extended multigenerational family is a core value of Hispanic culture. Family cohesion/pride can have protective effects on drinking- and drug-use-related behavior among Hispanics. Objectives: To examine the association between family cohesion/pride, drinking, binge drinking, and DSM-5 alcohol use disorder (AUD) in Puerto Rico. Methods: Data are from a household random sample of 1510 individuals 18–64 years of age in San Juan, Puerto Rico. Results: Bivariate analyses showed that family cohesion/pride was not associated with the average number of drinks consumed per week but was associated with binge drinking among men. Family cohesion/pride was also associated with DSM-5 AUD. Results of the multivariate analyses were consistent with these bivariate results for DSM-5 AUD. Respondents with low (OR = 2.2, 95CL = 1.21–3.98; p < .01) and medium (OR = 1.88; 95CL = 1.12–3.14; p < .01) family cohesion/pride were more likely than those with high family cohesion/pride to have a positive diagnosis of DSM-5 AUD. More liberal drinking norms and positive attitudes toward drinking were also strong predictors of the average number of drinks consumed per week. More liberal drinking norms also predicted binge drinking, and DSM-5 AUD. Conclusions: Higher family cohesion/pride may have a protective effect against DSM-5 AUD. This may have practical implications for clinical and prevention programs. As long as high cohesion is not enabling drinking, these programs can enhance and support family cohesion/pride to help clients in treatment and recovery and prevent drinking problems.

Deficits in Access to Reward Are Associated with College Student Alcohol Use Disorder.

Reward deprivation has been implicated in major depressive disorder and severe substance abuse, but its potential relation to alcohol use disorder (AUD) symptoms in non-treatment-seeking young adult drinkers is less clear. Depression is often comorbid with alcohol misuse, so relations of AUD with reward deprivation might be due in part to the presence of depressive symptoms in young adults. Behavioral economic theory views addiction as a state that is related in part to deficits in drug-free rewards, and therefore requires an investigation into whether reward deprivation has a direct relation to alcohol misuse that is, at least partially, independent of mood. This study evaluates the contribution of 2 facets of reward deprivation (reward availability and experience) to alcohol use, AUD symptoms, and depression in a sample of young adult heavy episodic drinkers. Data were collected from 392 undergraduates (60.4% female, 85.1% Caucasian) who reported recent heavy drinking (83.7% with at least 1 AUD symptom). Low reward availability (environmental suppression) was significantly associated with both DSM-5 AUD symptoms and alcohol-related problems after controlling for age, gender, depressive symptomatology, and drinking level. This study provides support for behavioral economic models that emphasize reward deprivation as a unique risk factor for AUD that is independent of mood and drinking level. Limited access to natural rewards may be a risk and/or maintaining factor for AUD symptoms in college student drinkers.

Dual cannabis and alcohol use disorders in young adults: Problems magnified

ABSTRACTBackground: Alcohol and marijuana are the 2 most commonly used substances among young adults. The present study examines whether having 2 DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) diagnoses (alcohol and cannabis) is associated with greater problems than having 1 (alcohol or cannabis) diagnosis. Methods: Participants were 307 young adults (18–25 years) from the community who met criteria for DSM-5 alcohol use disorder (AUD), cannabis use disorder (CUD), or both (dual use disorder [DUD]). Participants reported alcohol and marijuana use in the past 90 days (Timeline Follow-Back), alcohol problems (Short Inventory of Problems), and marijuana problems (Marijuana Problems Scale). Results: Eighty-four participants (27.4%) met criteria for AUD, 107 (34.9%) met criteria for CUD, and 116 (37.8%) met criteria for DUD. In multivariate analyses, the DUD group reported greater alcohol use frequency and more alcohol problems than the CUD-only group but not the AUD-only group. However, DUD individuals reported greater drinking intensity than singly diagnosed individuals. Those with DUD reported a greater proportion of marijuana consumption days than the AUD-only group but not the CUD-only group. However, DUD individuals reported more marijuana problems than both singly diagnosed groups. Conclusions: Results show that the concurrent presence of both DSM-5 AUD and CUD is associated with heavier drinking patterns and greater marijuana problems than disordered use of either substance alone, thus affirming the magnified severity of alcohol and marijuana use that accompanies dual DSM-5 alcohol and marijuana use disorders.

Adolescent Predictors of a Typology of DSM-5 Alcohol Use Disorder Symptoms in Young Adults Derived by Latent Class Analysis Using Data From an Australian Cohort Study.

There is little research examining alcohol use disorder (AUD) symptoms (based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]) in young adulthood. We assessed symptom structure at 24 years using latent class analysis (LCA), examining relationships between class membership and (a) concurrent alcohol use and DSM-5 AUD severity and (b) adolescent risk factors. A stratified, random sample of 1,943 adolescents ages 14-15 years was recruited from 44 secondary schools in Victoria, Australia, and interviewed during adolescence and young adulthood. We report findings on drinkers who completed the AUD module (N = 1,268; 51% male). Data clearly fit a three-class, dimensional model, comprising "mild symptoms" (63.2%), "moderate symptoms" (32.2%), and "severe symptoms" (4.6%) classes. Class membership was validated by concurrent drinking patterns and in reasonable agreement with DSM-5 AUD severity categories. Relative to mild symptoms class membership, moderate symptoms class membership increased odds of adolescent alcohol problems (odds ratio [OR] = 2.0, 95% CI [1.2, 3.5]) and persisting anxiety/depression symptoms (OR = 1.9, 95% CI [1.2, 3.1]). Daily smoking (OR = 2.6, 95% CI [1.1, 5.9]), persisting anxiety/ depression symptoms (OR = 2.5, 95% CI [1.3, 5.0]), and antisocial behavior (OR = 3.2, 95% CI [1.5, 6.8]) increased odds of severe symptoms class membership. Adolescent daily smoking (OR = 0.3, 95% CI [0.11, 0.81]) and antisocial behavior (OR = 0.3, 95% CI [0.14, 0.64]) were less likely among members of the moderate symptoms class, relative to the severe symptoms class. We found support for a dimensional AUD typology like that in DSM-5. Young adults with more severe AUD symptoms had a different adolescent risk profile than those in the low and moderate classes. These findings provide a focus for preventive intervention in adolescence to limit the severity of AUDs in young adulthood.

Performance of the AUDIT in Detecting DSM-5 Alcohol Use Disorders in College Students

ABSTRACTBackground: It is critical that our alcohol screening instruments maintain their accuracy at detecting DSM-5 Alcohol Use Disorder (AUD) symptomatology. The Alcohol Use Disorders Identification Test (AUDIT) is one of the most widely used alcohol screening instruments, despite no studies evaluating its performance for detecting DSM-5 AUDs. Objectives: The present study evaluated the performance of the AUDIT in the screening of DSM-5 AUDs in non-treatment seeking college students. Methods: Participants (N = 251) were undergraduate students who had at least one binge drinking occasion in the past 90-days. Results: The AUROC value for DSM-5 AUD status in the overall sample was.779 (SE =.029; 95% CIs =.721 to.837). The AUROC values for the reference groups of any DSM-IV AUD and any binge drinker were.798 (SE =.028; 95% CIs =.742 to.853) and.827 (SE =.03; 95% CIs.768 –.886), respectively. A similar pattern of findings emerged between males and females. Gender differences emerged in the identification of AUDIT cut-off scores. A score of ≥ 8 and ≥ 9 had the best balance of sensitivity and specificity for females and males in college, respectively. Conclusion: Findings indicate that the AUDIT has a reasonable degree of diagnostic proficiency in screening for DSM-5 AUDs in college students.

Subthreshold problem drinkers in DSM-5 alcohol use disorder classification.

The DSM-5 defined alcohol use disorder (AUD) to better cover undiagnosed subthreshold alcohol users, but few studies have investigated this topic. This study aimed to test whether subthreshold problem drinkers were a distinct subgroup of undiagnosed drinkers according to the DSM-5 AUD classification by investigating drinking patterns and longitudinal trajectories. Data were collected in the Cohort Study on Substance Use Risk Factors from young Swiss men in their early twenties (n = 4,630) at two time points. Participants responded to the 11 criteria of the DSM-5 AUD and to variables related to drinking patterns. Among drinkers, 23.2% and 23.5% of the participants were subthreshold problem drinkers at baseline and follow-up, respectively. The trends showed that 29.4% of them remained subthreshold problem drinkers over time. Those who remained subthreshold problem drinkers or progressed to AUD status were likely to meet the same criterion/add a new one. Subthreshold problem drinkers showed concurrent and later drinking patterns that were in between those of symptom-free drinkers and AUD drinkers. Subthreshold problem drinkers were an important subgroup of drinkers with risky drinking patterns, but they did not necessarily progress to later AUD status and did not appear to be a consistent subgroup over time. Subthreshold problem drinkers did not seem to be a subgroup of undiagnosed problem drinkers in the current DSM-5 classification. The results showed that AUD appeared to be a dimensional construct, in which one additional criterion was associated with worse alcohol-related outcomes. (Am J Addict 2016;25:408-415).

Factors Explaining Variation in Alcohol Use Disorder Prevalence Across Border and Nonborder Communities in Texas.

U.S. border populations have been found to be at high risk for alcohol problems. However, results from the U.S.-Mexico Study on Alcohol and Related Conditions (UMSARC) revealed surprisingly large variation in alcohol outcomes even among Texas border sites, with alcohol use disorder (AUD) prevalence ~1.5 to 1.6 times greater in the border city of Laredo compared to both San Antonio and the border site of McAllen/Brownsville. Because a better understanding of this variation is important to identifying environmental influences on AUD, we developed and tested a conceptual model addressing variation in AUD prevalence across Texas UMSARC sites. Surveys involved in-person, household interviews with Mexican-origin residents of the Texas border cities Laredo (n=751) and McAllen/Brownsville (n=814), with San Antonio as an off-border comparison (n=771). Interviews assessed past-year DSM-5 AUD; past-year heavy drinking; coping and enhancement motives; and 7 indicators of substance use climate and stress exposure hypothesized to mediate site effects. Analyses, conducted separately by gender, included regressions and structural equationmodeling with Mplus. Preliminary analyses revealed that site effects on AUD prevalence were, unexpectedly, exclusive to men, and that Laredan men were similar to McAllen/Brownsville men on demographics, acculturation, and cross-border mobility. However, sites differed dramatically on most of the hypothesized risk factors. Structural equationmodels confirmed that site effects on AUD were partially mediated via effects of site on indicators of a permissive climate (i.e., permissive drinking norms, high drug availability) and stress exposures (i.e., high exposure to violence/crime, low family support), and via downstream effects on drinking motives and heavy drinking. Findings of very high rates of past-12-month AUD among Laredan men (35%) suggest the possibility of significant heterogeneity even within demographically similar border areas and underline the need for additional study of the border region. Findings regarding our conceptual model suggest that this model may constitute a useful initial framework for future research on alcohol problems at the border. However, additional research using representative samples is needed to confirm and expand this model to comprehensively address relevant individual and community factors.

Treatment Seeking for Alcohol Use Disorders: Treatment Gap or Adequate Self-Selection?

Background/Aims: This study examines whether it is harmful that subjects with an alcohol use disorder (AUD) in the general population rarely seek treatment. Methods: Baseline and 3-year follow-up data from the Netherlands Mental Health Survey and Incidence Study-2 were used. Treatment utilization covered a 4-year period. The Composite International Diagnostic Interview 3.0 assessed AUD and other psychiatric disorders. Results: Of 154 subjects with baseline 12-month DSM-5 AUD, 35.4% used only general treatment (GenTx) for mental problems or alcohol/drugs problems; 10.3% used specialized AUD treatment (AUDTx); and 54.3% used no treatment at all. Of these 3 groups, AUDTx users had the highest severity on AUD characteristics, comorbid psychopathology and mental functioning. Compared to non-treatment (NonTx), GenTx users more often had 12-month emotional disorders at follow-up, but AUD remission rates and functioning were similar. NonTx users functioned similarly at follow-up as people in the general population without lifetime AUD or other psychopathology. Conclusion: Adequate treatment seeking often occurs in the general population: the most severe AUD subjects use AUDTx, and most NonTx users have a mild AUD and a favorable course. Current findings suggest a smaller treatment gap than previously reported, but still one-quarter of the people with AUD do not seek AUDTx but could benefit from this, as they have a persistent AUD.

Screening for Underage Drinking and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Alcohol Use Disorder in Rural Primary Care Practice

To examine the National Institute on Alcohol Abuse and Alcoholism Youth Guide alcohol frequency screening thresholds when applied to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnostic criteria, and to describe alcohol use patterns and alcohol use disorder (AUD) characteristics in rural youth from primary care settings. Adolescents (n=1193; ages 12 through 20 years) visiting their primary care practitioner for outpatient visits in six rural primary care clinics were assessed prior to their practitioner visit. A tablet computer collected youth self-report of past-year frequency and quantity of alcohol use and DSM-5 AUD symptoms. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. For early adolescents (ages 12 through 14years), 1.9% met DSM-5 criteria for past-year AUD and ≥3days with alcohol use in the past year yielded a screen for DSM-5 with optimal psychometric properties (sensitivity: 89%; specificity: 95%; PPV: 37%; NPV: 100%). For middle adolescents (ages 15 through 17years), 9.5% met DSM-5 AUD criteria, and ≥3 past year drinking days showed optimal screening results (sensitivity: 91%; specificity: 89%; PPV: 50%; NPV: 99%). For late adolescents (ages 18 through 20years), 10.0% met DSM-5 AUD criteria, and ≥12 past year drinking days showed optimal screening results (sensitivity: 92%; specificity: 75%; PPV: 31%; NPV: 99%). The age stratified National Institute on Alcohol Abuse and Alcoholism frequency thresholds also produced effective results. In rural primary care clinics, 10% of youth over age 14 years had a past-year DSM-5 AUD. These at-risk adolescents can be identified with a single question on alcohol use frequency.