DSM-IV Alcohol Use Research Articles

Modeling the Dimensionality of DSM-IV Alcohol Use Disorder Criteria in a Nationally Representative Sample of College Students

This study examined the dimensionality of DSM-IV alcohol use disorder (AUD) criteria in a nationally representative sample of college students (N = 4,605) using latent variable techniques. We used data from the 2009 National Survey of Drug Use and Health and selected those who were currently enrolled in college and current drinkers. Confirmatory factor analysis provided support for a one-factor solution of the AUD criteria. Item Response Theory analyses indicated that the alcohol abuse and dependence criteria severity parameters were intermixed along the AUD severity continuum with high discrimination parameters. Findings support reformulating the current AUD diagnostic system for the DSM-V. Study's limitations are noted.

Drinking Correlates of DSM-IV Alcohol Use Disorder Diagnostic Orphans in College Students

One major limitation of the DSM-IV criteria for alcohol abuse and dependence is that a cluster of individuals who endorse a subthreshold number of dependence criteria and no abuse criteria do not receive a formal diagnosis; despite elevated risk for alcohol-related problems relative to those with an abuse diagnosis. These individuals have been referred to as diagnostic orphans. The primary aim of this study was to examine alcohol use correlates of a group of diagnostic orphans in a sample of 396 nontreatment seeking college students who reported drinking on at least one occasion in the last 90 days. DSM-IV criteria were assessed using a modified version of the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). Diagnostic orphans represented 34.1% (n = 135) of the original sample who did not receive a formal diagnosis; with the most frequently endorsed dependence criteria being tolerance and drinking larger/longer amounts than intended. Diagnostic orphans reported a range of alcohol-related negative consequences and reported greater frequencies of social and enhancement drinking motives in comparison to coping motives. They were similar to alcohol abusers and dissimilar to those with dependence or those without a diagnosis on alcohol consumption, alcohol problem severity, drinking motives and restraint variables. The present findings indicate that diagnostic orphans in college students represent a distinct group of drinkers who may be at risk for the development of alcohol use disorders and may be in need of intervention, given their similarity to those with an abuse diagnosis. Prevention and intervention efforts across college campuses should target this group to prevent escalation of alcohol problem severity.

Mental Health Service Use by Persons of Asian Ancestry With DSM-IV Mental Disorders in the United States

This study compared the prevalence and odds of mental health service utilization among people of Asian ancestry with lifetime DSM-IV mood, anxiety, alcohol, and drug use disorders with utilization by members of other racial and ethnic groups with similar disorders. Between 2001 and 2002, a total of 43,093 noninstitutionalized individuals were assessed by the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study of lifetime prevalence of DSM-IV psychiatric disorders and mental health service utilization among various ethnic and racial groups. Among individuals with lifetime mood disorders, Asians had significantly lower mental health service utilization compared with whites (odds ratio [OR]=.31, 95% confidence interval [CI]=.21-.46), Hispanics (OR=.49, CI=.33-71), and Native Americans (OR=.27, CI=.15-.48) but similar utilization compared with blacks. There were no statistically significant differences in lifetime mental health service utilization for alcohol and drug use disorders among racial and ethnic groups. Asians with lifetime mood disorders underutilized mental health services even after adjustment was made for socioeconomic variables and years of residency in the United States. Future studies of culture-specific attitudes, correlates, and barriers to mental health service utilization are warranted.

Psychometric Performance of DSM-IV Alcohol Use Disorders in Young Adulthood: Evidence From an Australian General Population Sample

The current study investigates the performance of alcohol use disorders in young adults using item response theory and differential item functioning (DIF). The 1997 National Survey of Mental Health and Wellbeing (Australia) sample was based on a stratified, multistage area probability sample of people ages 18 years and older in the Australian population. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), alcohol use disorders were assessed in all current alcohol users (N = 7,746; 44.2% female). The psychometric properties of the DSM-IV alcohol use disorder criteria in young adults were assessed using item response theory. Age-based DIF was also assessed in each of the DSM-IV criteria for alcohol use disorders. The presence of age-based DIF in subgroups defined by sex and consumption was also examined. Overall, problems were identified in the use in hazardous situations, persistent desire/inability to quit/cut down, and tolerance criteria in young adults. However, the DIF identified at the criterion level had little impact on total information provided by the criteria across the two age groups. Subgroup analyses indicated that for the female-only and non-heavy using subgroups, DIF was no longer detected in the use in hazardous situations criterion. The alcohol use disorder criteria were found to provide maximum information about moderate to severe pathology among young adults. There was little evidence for the DSM-IV abuse/dependence distinction in young adulthood. Some of the DSM-IV alcohol use disorder criteria appear problematic when applied to young adults, and future research needs to focus on clarifying young adults' understanding of these problematic criteria. Although DIF was identified in three of the alcohol use disorder criteria, the total information provided by these criteria was largely the same among younger and older age groups.

S01 * ALCOHOL USE DISORDER DSM V DRAFT CRITERIA: DEVELOPMENT AND APPLICABILITY IN ADOLESCENT AND ADULT SAMPLES * S01.1 * DSM V DEVELOPMENT AND APPLICABILITY TO ADOLESCENT/YOUNG ADULT POPULATIONS

S01 * ALCOHOL USE DISORDER DSM V DRAFT CRITERIA: DEVELOPMENT AND APPLICABILITY IN ADOLESCENT AND ADULT SAMPLES * S01.1 * DSM V DEVELOPMENT AND APPLICABILITY TO ADOLESCENT/YOUNG ADULT POPULATIONS

Toward DSM-V: Mapping the alcohol use disorder continuum in college students

ObjectiveThe present study examined the dimensionality of DSM-IV Alcohol Use Disorder (AUD) criteria using Item Response Theory (IRT) methods and tested the validity of the proposed DSM-V AUD guidelines in a sample of college students. MethodParticipants were 396 college students who reported any alcohol use in the past 90 days and were aged 18 years or older. We conducted factor analyses to determine whether a one- or two-factor model provided a better fit to the AUD criteria. IRT analyses estimated item severity and discrimination parameters for each criterion. Multivariate analyses examined differences among the DSM-V diagnostic cut-off (AUD vs. No AUD) and severity qualifiers (no diagnosis, moderate, severe) across several validating measures of alcohol use. ResultsA dominant single-factor model provided the best fit to the AUD criteria. IRT analyses indicated that abuse and dependence criteria were intermixed along the latent continuum. The “legal problems” criterion had the highest severity parameter and the tolerance criterion had the lowest severity parameter. The abuse criterion “social/interpersonal problems” and dependence criterion “activities to obtain alcohol” had the highest discrimination parameter estimates. Multivariate analysis indicated that the DSM-V cut-off point, and severity qualifier groups were distinguishable on several measures of alcohol consumption, drinking consequences, and drinking restraint. DiscussionFindings suggest that the AUD criteria reflect a latent variable that represents a primary disorder and provide support for the proposed DSM-V AUD criteria in a sample of college students. Continued research in other high-risk samples of college students is needed.

An evaluation of the proposed DSM‐5 alcohol use disorder criteria using Australian national data

To evaluate the proposed revisions to the DSM-IV alcohol use disorder criteria using epidemiological data. Data came from the 1997 Australian National Survey of Mental Health and Well-Being. The sample consisted of 10, 641 participants aged 18 years and over. Alcohol use disorders were assessed using a revised version of the CIDI version 2.0. Alcohol use disorders were assessed in all respondents who indicated that they had used alcohol more than 12 times in the previous 12 months (n = 7746). The proposed introduction of a single alcohol use disorder was supported by confirmatory factor analysis (CFA). DSM-5 criteria were all indicators of a single underlying disorder. Under DSM-5, the prevalence of alcohol use disorders would increase by 61.7% when compared with those diagnosed under DSM-IV. When investigating the most appropriate diagnostic threshold, the 3+ threshold maximized agreement between DSM-IV and DSM-5 diagnoses, and produced similar prevalence estimates to those yielded by DSM-IV. Item response theory (IRT) analyses supported the removal of the legal criterion while provided equivocal results for the craving criterion. Under the proposed DSM-IV revisions for alcohol use disorders, estimates of the prevalence in the general population would increase substantially. Whereas evidence supports some of the revisions such as a single underlying disorder, others such as the 2+ threshold for diagnosis of alcohol use disorder and the inclusion of a 'craving' criterion may be problematic.

Assessing the Dimensionality of Lifetime DSM-IV Alcohol Use Disorders and a Quantity-Frequency Alcohol Use Criterion in the Australian Population: a Factor Mixture Modelling Approach

With the revision of the DSM-IV underway, two important research issues currently dominate the addiction literature: (a) how can the dimensionality of DSM-IV alcohol use disorders (AUD) diagnostic criteria best be described? and (ii) should a quantity-frequency alcohol use (QF) criterion be added to the existing diagnostic criteria set in the DSM-V? The current study addressed these aims by analysing lifetime data from a recent Australian population survey. Data from adults screened for lifetime DSM-IV AUD in the 2007 National Survey on Mental Health and Wellbeing (NSMHWB) were analysed (n=5409). A series of alternative factor analytic, latent class and factor mixture or 'hybrid' models were used to assess the dimensionality of lifetime DSM-IV AUD diagnostic criteria and a lifetime QF criterion. Examination of the goodness-of-fit indices revealed that a one-factor or a two-factor model, a three-class latent class model or a two-factor zero-class hybrid model, were all acceptable models for the data. A simple structure one-factor model was considered to be the most parsimonious and theoretically meaningful model, given the high correlation between the abuse and dependence factors (0.874) in the two-factor model. The inclusion of the QF criterion did not enhance the fit of the one-factor model. Incorporating both dimensional and categorical conceptions of lifetime AUD did not provide substantial gains over a simple structure unidimensional model of AUD severity. The utility of a QF use criterion in helping to diagnose AUD is questionable. These findings should be of relevance to the DSM-5 substance use disorder workgroup.

Deconstructing the architecture of alcohol abuse and dependence symptoms in a community sample of late adolescent and emerging adult women: An item response approach

The objective of this study was to examine the underlying factorial architecture of lifetime DSM-IV alcohol use disorder (AUD) criteria in a population-based sample of adolescent and emerging adult female twins who had ever used alcohol (n=2832; aged 18–25 years), and to determine whether thresholds and factor loadings differed by age. Item response modeling was applied to DSM-IV AUD criteria. Compound criteria (e.g., persistent desire or unsuccessful attempts to quit or cut down) were included as separate items. Of the remaining 16 items, tolerance and use despite physical problems were the most and least commonly endorsed items, respectively. Underlying the items was a single factor representing liability to AUDs. Factor loadings ranged from 0.67 for blackouts to 0.90 for time spent using/recovering from effects. Some items assessing different DSM-IV criteria had very similar measurement characteristics, while others assessing the same criterion showed markedly different thresholds and factor loadings. Compared to that of women aged 21–25 years, the threshold for hazardous use was higher in women aged 18–20 years, but lower for used longer than intended and persistent desire to cut down. After accounting for threshold differences, no variations in discrimination across age groups were observed. In agreement with the extant literature, our findings indicate that the factorial structure of AUD is unidimensional, with no support for the abuse/dependence distinction. Individual components of compound criteria may differ in measurement properties; therefore pooling information from such divergent items will reduce information about the AUD construct.

Binge Drinking and Axis I Psychiatric Disorders in Community-Dwelling Middle-Aged and Older Adults

The aims of this study were to document the sociodemographic correlates of binge drinking in middle-aged and older adults and to test the association of binge drinking with the occurrence of DSM-IV mood, anxiety, and alcohol use disorders; smoking; and the use of illicit drugs independently of sociodemographic variables and lifetime diagnosis of the disorder in question. We conducted secondary data analyses based on a subsample of a 3-year prospective, population-based study, the National Epidemiologic Survey on Alcohol and Related Conditions, which consisted of a nationally representative sample of 13,489 American community-dwelling adults aged 50 years and above, interviewed in both 2001-2002 and 2004-2005. This survey assessed the occurrence of 11 DSM-IV mood, anxiety, and alcohol use disorders; nicotine dependence; and the use of illicit drugs during the 3-year follow-up period by using the National Institute on Alcohol Abuse and Alcoholism's Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. We found that, among persons aged 50 years and above, 15.6% of men and 5.7% of women reported binge drinking in the year prior to baseline assessment in 2001-2002. After adjustment was made for covariates, both men who were occasional binge drinkers and men who were frequent binge drinkers were significantly more likely than current male drinkers without binge drinking to have alcohol abuse disorder (adjusted odds ratio [AOR] = 2.90 [95% CI, 1.82-4.62] and AOR = 5.68 [95% CI, 3.79-8.51], respectively) and alcohol dependence disorder (AOR = 3.69 [95% CI, 1.75-7.75] and AOR = 9.21 [95% CI, 5.59-15.18], respectively). Similarly, after adjustment was made for covariates, both women who were occasional binge drinkers and women who were frequent binge drinkers were significantly more likely than current female drinkers without binge drinking to have alcohol abuse disorder (AOR = 4.43 [95% CI, 1.85-10.60] and AOR = 3.49 [95% CI, 1.64-7.43], respectively) and alcohol dependence disorder (AOR = 5.20 [95% CI, 1.56-17.33] and AOR = 19.47 [95% CI, 7.59-49.98], respectively). In addition, in female subjects, occasional binge drinking was associated with an increased risk of panic disorder without agoraphobia (AOR = 2.23; 95% CI, 1.01-4.91) and posttraumatic stress disorder (AOR = 2.67; 95% CI, 1.05-6.84). Binge drinking is strongly associated with a higher risk of alcohol use disorder in middle-aged and older adults in the United States. Results provide valuable information on the risks associated with binge drinking and suggest targets for prevention strategies for mental health in middle and old age.

The role of mental disorders in the risk and speed of transition to alcohol use disorders among community youth

Among adolescents and young adults with DSM-IV alcohol use disorders (AUDs), there are inter-individual differences in the speed of transition from initial alcohol use (AU) to AUD. AUDs are highly co-morbid with other mental disorders. The factors associated with rapid transition from first AU to AUD remain unknown and the role of mental disorders in rapid transitions is unclear. Given this background we examined (1) whether prior anxiety, mood, externalizing and non-alcohol substance use disorders are related to the risk and speed of transition from first AU to DSM-IV alcohol abuse (AA) and alcohol dependence (AD) and (2) whether early age of onset of prior mental disorders (PMDs) is a promoter of rapid transition. A total of 3021 community subjects (97.7% lifetime AU) aged 14-24 years at baseline were followed up prospectively for up to 10 years. AU and mental disorders were assessed with the DSM-IV/M-CIDI. Among subjects with lifetime AU, several PMDs, such as specific phobia, bipolar disorder and nicotine dependence, were associated with an increased risk of AUD independent of externalizing disorders. Associations of PMDs with the speed of transition to AUDs were mostly weak and inconsistent. Only social phobia and externalizing disorders were associated with faster transitions to AD even after adjustment for other PMDs. Earlier age of onset of PMD was not associated with rapid transition. Mental disorders are associated with the risk of AUD. With the possible exception of social phobia and externalizing disorders, they do not promote rapid transition, even if they occur particularly early. Future research needs to identify factors relevant to rapid transition to AUD.

Continuous, categorical and mixture models of DSM‐IV alcohol and cannabis use disorders in the Australian community

To apply item response mixture modelling (IRMM) to investigate the viability of the dimensional and categorical approaches to conceptualizing alcohol and cannabis use disorders. A cross-sectional survey assessing substance use and DSM-IV substance use disorders. A household survey of a nationally representative sample of 10,641 Australia adults (aged 18 years or older). Trained survey interviewers administered a structured interview based on the Composite International Diagnostic Interview (CIDI). Of the 10,641 Australian adults interviewed, 7746 had drunk alcohol in the past 12 months and 722 had used cannabis. There was no improvement in fit for categorical latent class nor mixture models combining continuous and categorical parameters compared to continuous factor analysis models. The results indicated that both alcohol and cannabis problems can be considered as dimensional, with those with the disorder arrayed along a dimension of severity. A single factor accounts for more variance in the DSM-IV alcohol and cannabis use criteria than latent class or mixture models, so the disorders can be explained most effectively by a dimensional score.

The dimensionality of alcohol use disorders: Results from Israel

Aims To prepare for DSM-V, the structure of DSM-IV alcohol dependence and abuse criteria and a proposed additional criterion, at-risk drinking, require study in countries with low per-capita consumption, and comparison of current and lifetime results within the same sample. We investigated DSM-IV Alcohol Use Disorder (AUD) criteria in Israel, where per-capita alcohol consumption is low. Methods Household residents selected from the Israeli population register ( N = 1338) were interviewed with the AUDADIS. Item response theory analyses were conducted using MPlus, and diagnostic thresholds were examined with the kappa statistic. Results Dependence and abuse criteria fit a unidimensional model interspersed across the severity continuum, for both current and lifetime timeframes. Legal problems were rare and did not improve model fit. Weekly at-risk drinking reflected greater severity than in U.S. samples. When dependence and abuse criteria were combined, a diagnostic threshold of ≥3 criteria produced the best agreement with DSM-IV diagnoses (kappa > 0.80). Conclusion Consistent with other studies, alcohol dependence and abuse criteria reflected a latent variable representing a single AUD. Results suggested little effect in removing legal problems and little gained by adding weekly at-risk drinking. Results contribute to knowledge about AUD criteria by examining them in a low-consumption country.

The Effect of Inmate Populations on Estimates of DSM-IV Alcohol and Drug Use Disorders in the United States

To The Editor: Most national estimates of adult DSM-IV substance use disorder (e.g., National Epidemiologic Survey on Alcohol and Related Conditions [1], and National Survey on Drug Use and Health [2]) are based on household samples that exclude prison and jail inmates, populations known to have high rates of substance use disorders. To estimate the effect of excluding inmates, we present estimates of alcohol and drug use disorders for household and inmate populations and calculate the change in the overall prevalence of substance use disorder when these two populations are pooled. Prevalence estimates for the combined U.S. household and inmate population are weighted averages of the survey-weighted prevalence estimates for the household population, state prison population, federal prison population, and jail population (1, 3–5). As seen in Table 1, details about interviewing and how weighted averages and standard errors were calculated are reported (also see the data supplement accompanying the online version of this letter). Table 1 Effect of Adding the Inmate Population to Household Prevalence and Population Estimates of the Prevalence of Past 12 Month DSM-IV Alcohol and Drug Use Disorders in U.S. Adults Including inmates increased overall projected estimates of the number of persons in the United States aged ≥18 years with an alcohol use disorder by 877,000, from 17,580,000 to 18,457,000, a 5.0% increase over the base. Estimates of the number with an illicit drug use disorder increased by 1,043,000, from 4,159,000 to 5,202,000, a 25.1% increase. Overall prevalence of the specific alcohol abuse and dependence disorders increased over the base by 4.2% and 5.9% respectively, and illicit drug abuse and dependence increased by 12.0% and 53.8%. High rates of DSM-IV substance use disorders among inmates combined with a large inmate population means that many persons with alcohol and drug use disorders are missed by major U.S. national general population surveys. The undercount for both alcohol and illicit drug disorders is significant, but proportionately the undercount for alcohol disorders is modest while the proportionate undercount for illicit drug disorders, particularly illicit drug dependence (i.e., addiction), is large. These results likely would be accentuated for substances such as cocaine, methamphetamine, and heroin, which are rare in the household population (2) but common among inmates (4–5). In addition, prevalence rates may be particularly underestimated for men and for those minority populations that are overrepresented in the inmate population. To improve accuracy and cover the full range of cases, the U.S. surveillance system may need to be modified. In addition, further investigation of the effect of incarceration on estimates for specific subpopulations is warranted.

Are subthreshold alcohol dependence symptoms a risk factor for developing DSM-IV alcohol use disorders? A three-year prospective study of ‘diagnostic orphans’ in a national sample

Aims Research suggests that diagnostic orphans (i.e., individuals experiencing only 1–2 criteria for DSM-IV alcohol dependence) may be at increased risk for developing more severe alcohol problems. This study aimed to: (i) investigate the course of diagnostic orphans in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), and (ii) explore whether a specific symptom endorsement pattern(s) could identify diagnostic orphans at Wave 1 who remitted or progressed to alcohol dependence at Wave 2. Methods Current drinkers ( n = 15,751) were divided into diagnostic groups at Waves 1 and 2: no-alcohol use disorder (AUD); one-criterion orphans, two-criterion orphans, alcohol abuse, or alcohol dependence. Multinomial logistic regression analysis explored the association between diagnostic status at Wave 1 and Wave 2. Chi-square tests investigated differences in the criteria endorsement patterns of diagnostic orphans. Results Compared to the no-AUD group, one-criterion orphans at Wave 1 were twice as likely to be in the abuse group and four times more likely to be dependent at Wave 2. Two-criterion orphans were three times more likely to be in the abuse group and eight times more likely to have progressed to dependence. Criterion endorsement patterns of diagnostic orphans at baseline did not significantly differentiate between those who remitted and those who progressed to dependence at follow-up. Conclusions Like previous research, diagnostic orphans are at increased for developing to more severe alcohol problems. Relying solely on the DSM-IV AUD diagnostic criteria, however, may not be sufficient to identify those diagnostic orphans who are at risk for progressing to dependence.

MORE ALCOHOL DEPENDENCE THAN ABUSE IN RURAL CHINA

Recent research has suggested a significant increase ofalcohol consumption and use disorders in China, andattributed this to a culturally lax attitude to binge-drinking, business-related drinking and the adoption ofwestern life-styles following globalization [1,2]. Accord-ingly, the pattern of DSM-IV alcohol use disorders inurban regions is now quite similar to those of westernpopulations [3,4]; that is, these disorders are mainlyprevalent among young to middle-aged males [2] andabuse is significantly more common than dependence[2,5]. However, about 70% of the Chinese populationconsists of rural and ethnic minority people, amongwhom recent DSM-IV-based community surveys repeat-edly found the prevalence of dependence to be signifi-cantly higher than that of abuse [6,7]. Moreover, bothdisordersaremoreprevalentamongoldermales[6,7].Insome surveys, including both urban and rural regions,the prevalence of dependence was also estimated to behigherthanthatof abuse[8].Thesefindingssuggestthatspecial aetiological pathways may shape the pattern ofalcohol use and its disorders in non-urban people inChina.Using both anthropological and epidemiologicalresearch methods [9], we found that drinking is a well-accepted means of relieving physical and psychologicalsymptomsamongolderChinesemeninruralandminor-ity areas. Many of them believe that alcohol can reducefatigue, relieve pain, enhance sleep and ‘expel wetnessand restore bodily imbalance’. Drinking after heavylabour,includingsolitarydrinkingamongolderpeople,isespecially popular [9]. Because of the perceived healthbenefits, regular drinking without binge drinking anddrunkennessisalocallyendorsedkindof self-medicationfor a variety of symptoms. None the less, consumptionlevels are often much larger than the professionally rec-ommended limit of ‘proper drinking’, and can result inalcohol dependence without apparently causing psycho-social problems associated with the diagnosis of alcoholabuse [9]. If they do occur, these problems are not dealtwithlegallybecausetherearefewpoliceofficersavailableto handle them. Drink-driving rarely occurs, as very fewpeople own a vehicle [7]. The physical complications ofalcohol dependence are rarely detected, because nearlyall rural or minority people no longer have access to freehealth care following privatization and the breakdown ofthepreviouslycollectivistichealthcaresystem[10].Con-sequently, there is ample time for dependence to developamong older male people in rural regions. As alcohol ismuch cheaper than health visits, future research shouldexamine in more detail how ‘self-medication withalcohol’ may explain the special pattern of alcohol usedisorders and its policy implications in China.This atypi-cal pattern has been discussed rarely in the literature,indicating that the diagnosis of alcohol abuse is morelikely to be shaped by socio-cultural factors than that ofdependence, which is more physiological in origin. Noso-logically, a dimensional and more quantitative approachto alcohol use disorders that integrates the features ofboth abuse and dependence is worth considering in theDSM-V [11].

A multidimensional assessment of the validity and utility of alcohol use disorder severity as determined by item response theory models

Background The relative severity of the 11 DSM-IV alcohol use disorder (AUD) criteria are represented by their severity threshold scores, an item response theory (IRT) model parameter inversely proportional to their prevalence. These scores can be used to create a continuous severity measure comprising the total number of criteria endorsed, each weighted by its relative severity. Methods This paper assesses the validity of the severity ranking of the 11 criteria and the overall severity score with respect to known AUD correlates, including alcohol consumption, psychological functioning, family history, antisociality, and early initiation of drinking, in a representative population sample of U.S. past-year drinkers ( n = 26,946). Results The unadjusted mean values for all validating measures increased steadily with the severity threshold score, except that legal problems, the criterion with the highest score, was associated with lower values than expected. After adjusting for the total number of criteria endorsed, this direct relationship was no longer evident. The overall severity score was no more highly correlated with the validating measures than a simple count of criteria endorsed, nor did the two measures yield different risk curves. This reflects both within-criterion variation in severity and the fact that the number of criteria endorsed and their severity are so highly correlated that severity is essentially redundant. Conclusions Attempts to formulate a scalar measure of AUD will do as well by relying on simple counts of criteria or symptom items as by using scales weighted by IRT measures of severity.

The association between team climate at work and mental health in the Finnish Health 2000 Study

Objectives:Depression, anxiety and alcohol use disorders are common mental health problems in the working population. However, the team climate at work related to these disorders has not been studied using...

Toward DSM-V: An Item Response Theory Analysis of the Diagnostic Process for DSM-IV Alcohol Abuse and Dependence in Adolescents

ObjectiveItem response theory analyses were used to examine alcohol abuse and dependence symptoms and diagnoses in adolescents. Previous research suggests that the DSM-IV alcohol use disorder (AUD) symptoms in adolescents may be characterized by a single dimension. The present study extends prior research with a larger and more comprehensive sample and an examination of an alternative diagnostic algorithm for AUDs. MethodApproximately 5,587 adolescents between the ages of 12 and 18 years from adjudicated, clinical, and community samples were administered structured clinical interviews. Analyses were conducted to examine the severity of alcohol abuse and dependence symptoms and the severity of alcohol use problems (AUDs) within the diagnostic categories created by the DSM-IV. ResultsAlthough the DSM-IV diagnostic categories differ in severity of AUDs, there is substantial overlap and inconsistency in AUD severity of persons across these categories. Item Response Theory-based AUD severity estimates suggest that many persons diagnosed with abuse have AUD severity greater than persons with dependence. Similarly, many persons who endorse some symptoms but do not quality for a diagnosis (i.e., diagnostic orphans) have more severe AUDs that persons with an abuse diagnosis. Additionally, two dependence items, “tolerance” and “larger/longer,” show differences in severity between samples. ConclusionsThe distinction between DSM-IV abuse and dependence based on severity can be improved using an alternative diagnostic algorithm that considers all of the alcohol abuse and dependence symptoms conjointly.

Characteristics of DSM-IV alcohol diagnostic orphans: Drinking patterns, physical illness, and negative life events

BackgroundInterest in subthreshold psychiatric disorders has increased recently. Diagnostic orphans experience one to two criteria of alcohol dependence but do not meet the diagnostic criteria for a DSM-IV alcohol use disorder (AUD). This study investigated the impact of subthreshold alcohol symptoms on three domains: physical illness, drinking patterns, and the occurrence of negative life events. MethodCurrent drinkers (n=26,946) in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were divided into five diagnosis groups: no-AUD; one-criterion orphans (reference group), two-criterion orphans, alcohol abuse, and alcohol dependence. Exploratory factor analysis examined the factor structure of items in the Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS-IV) relating to each life domains. Factors were related to the diagnosis groups and background covariates using latent variable modeling. ResultsOne-criterion orphans did not differ from the other groups with regards to physical illness. One- and two-criterion orphans differed significantly in relation to drinking patterns, with the latter group engaging in hazardous drinking behaviours more frequently. The dependence group were more likely to experience higher estimates of social problems compared to one-criterion orphans. One-criterion orphans were more likely than the abuse group to experience financial problems but less likely than the dependence group to experience family-related legal problems. ConclusionsDiagnostic orphans were more impaired than those with no-AUD or alcohol abuse in specific life domains; however, diagnostic orphans were significantly less impaired than those with alcohol dependence. Diagnostic orphans may be an important group for early case identification and intervention.