DSM-IV Criteria For Alcohol Abuse Research Articles

Saracatinib Fails to Reduce Alcohol-Seeking and Consumption in Mice and Human Participants.

More effective treatments to reduce pathological alcohol drinking are needed. The glutamatergic system and the NMDA receptor (NMDAR), in particular, are implicated in behavioral and molecular consequences of chronic alcohol use, making the NMDAR a promising target for novel pharmacotherapeutics. Ethanol exposure upregulates Fyn, a protein tyrosine kinase that indirectly modulates NMDAR signaling by phosphorylating the NR2B subunit. The Src/Fyn kinase inhibitor saracatinib (AZD0530) reduces ethanol self-administration and enhances extinction of goal-directed ethanol-seeking in mice. However, less is known regarding how saracatinib affects habitual ethanol-seeking. Moreover, no prior studies have assessed the effects of Src/Fyn kinase inhibitors on alcohol-seeking or consumption in human participants. Here, we tested the effects of saracatinib on alcohol consumption and craving/seeking in two species, including the first trial of an Src/Fyn kinase inhibitor to reduce drinking in humans. Eighteen male C57BL/6NCrl mice underwent operant conditioning on a variable interval schedule to induce habitual responding for 10% ethanol/0.1% saccharin. Next, mice received 5 mg/kg saracatinib or vehicle 2 h or 30 min prior to contingency degradation to measure habitual responding. In the human study, 50 non-treatment seeking human participants who drank heavily and met DSM-IV criteria for alcohol abuse or dependence were randomized to receive 125 mg/day saracatinib (n = 33) or placebo (n = 17). Alcohol Drinking Paradigms (ADP) were completed in a controlled research setting: before and after 7–8 days of treatment. Each ADP involved consumption of a priming drink of alcohol (0.03 mg%) followed by ad libitum access (3 h) to 12 additional drinks (0.015 g%); the number of drinks consumed and craving (Alcohol Urge Questionnaire) were recorded. In mice, saracatinib did not affect habitual ethanol seeking or consumption at either time point. In human participants, no significant effects of saracatinib on alcohol craving or consumption were identified. These results in mice and humans suggest that Fyn kinase inhibition using saracatinib, at the doses tested here, may not reduce alcohol consumption or craving/seeking among those habitually consuming alcohol, in contrast to reports of positive effects of saracatinib in individuals that seek ethanol in a goal-directed manner. Nevertheless, future studies should confirm these negative findings using additional doses and schedules of saracatinib administration.

Gender Differences in Use of Alcohol Treatment Services and Reasons for Nonuse in a National Sample.

The majority of adults with alcohol use disorders do not obtain help, and women are less likely to utilize alcohol services than men. We sought to quantify gender differences in alcohol services utilization, overall and by type, using national longitudinal data and to explore potential gender differences in perceived need for help and reasons for not seeking help. We analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions from White, African American, and Hispanic adults (n=2,592) who met DSM-IV criteria for alcohol abuse or dependence at Wave 1 (2000 to 2001). We tested gender differences in Wave 2 (2004 to 2005) services utilization, perceived need for help, and treatment barriers using Rao-Scott chi-square tests and assessed predictors of outcomes in multivariable logistic regression, adjusting for problem severity, co-occurring disorders, and demographics. Women had much lower odds than men of utilizing any alcohol service (adjusted odds ratio [aOR] 0.53; 95% confidence interval [95% CI]: 0.33, 0.86), specialty services (aOR 0.41; 95% CI 0.19, 0.87), and 12-step groups (aOR 0.39; 95% CI 0.21, 0.71). Perceived need for help among those who had not used any services was very low (5%), with no gender difference. Further, men and women reported equivalent numbers of treatment barriers and the same rank order for the most frequently endorsed barriers. However, women were twice as likely as men to think a problem would get better by itself-the most frequent reason for not seeking help (47% vs. 24%, p<0.001), and men were more likely than women to report unsuccessful past help-seeking and not thinking anyone could help (19% vs. 3%, p<0.001 and 17% vs. 5%, p=0.001, respectively). Consistent with previous studies, women were less likely to utilize alcohol services than men. Future interventions should address low problem recognition, and tailoring to gender-specific barriers may help close the disparity in services utilization.

Association of Physical Activity with Alcohol Abuse and Dependence in a Nationally-Representative U.S. Sample

ABSTRACTBackground: Alcohol use is a pervasive and costly public health problem in the United States. Relapse rates from alcohol use disorders are high. Although exercise has been proposed as a strategy to prevent relapse, lifestyle modification is the least studied aspect of relapse prevention programs, especially among racial/ethnic minority populations.Objective: The current study assessed whether being physically active was associated with remission from alcohol abuse or dependence among Black (African American and Afro Caribbean) adults in the U.S.Method: We utilized data on Black adult participants (n = 4,828) from the nationally representative National Survey of American Life (NSAL) conducted in 2001–2003. Logistic regression models were estimated to assess the odds of being in 12-month remission or currently meeting DSM-IV criteria for alcohol abuse or dependence based on level of physical activity, adjusting for socio-demographic and neighborhood characteristics.Results: People who endorsed being physically active had higher odds of being in 12-month remission from alcohol use problems (OR: 1.67, 95% CI: 1.28, 2.17) than people who were physically inactive, adjusting for individual- and neighborhood-level characteristics. People who were physically active did not differ significantly from those who were inactive with respect to odds of currently meeting DSM-IV criteria for alcohol abuse or dependence.Conclusions/Importance: Physical activity was positively associated with being in 12-month remission from alcohol use problems. Longitudinal studies are needed to establish temporal ordering and to explore exercise as a potential relapse prevention strategy for alcohol use problems.

Abstinence based incentives plus parent training for adolescent alcohol and other substance misuse.

The purpose of this study was to conduct a randomized test of clinic- and home-based incentives plus parent training for adolescent problem alcohol use. Adolescents (N = 75) with alcohol misuse, with or without other substance misuse, were enrolled. All youth received individual Motivational Enhancement Therapy/Cognitive Behavior Therapy and weekly urine drug testing. The experimental condition (EXP) included Abstinence Incentives (clinic-based incentives for abstinence from all substances) plus weekly behavioral parent training that included a parent-delivered, abstinence-based, substance monitoring contract. The comparison condition (CONTROL) included Attendance Incentives (ATTI). All adolescents met DSM-IV criteria for alcohol abuse or dependence or reported recent binge drinking, and 77% (N = 58) met criteria for a cannabis use disorder or had recent cannabis use at baseline. Alcohol and cannabis use outcomes were compared across treatment conditions. A similar percentage of youth maintained complete alcohol abstinence across the 36-week follow-up in both conditions. However, among youth not entirely abstinent from alcohol, EXP resulted in a lower percentage of days using alcohol during the 36 weeks after the end of treatment than CONTROL. Among youth who also used cannabis at baseline, results showed similar benefits of EXP on cannabis use days. Combined individual and family based treatment, plus abstinence based incentives can reduce substance use days during and after treatment over and above individual evidence-based psychosocial treatment plus attendance incentives. Future research should focus on identifying cost-effective components and incentive levels and delivery via technology to facilitate dissemination. (PsycINFO Database Record

Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial

BackgroundMost patients with alcohol use disorders (AUDs) never receive alcohol treatment, and experts have recommended management of AUDs in primary care. The Choosing Healthier Drinking Options In primary CarE (CHOICE) trial was a randomized controlled effectiveness trial of a novel intervention for primary care patients at high risk for AUDs. This report describes the conceptual and scientific foundation of the CHOICE model of care, critical elements of the CHOICE trial design consistent with the Template for Intervention Description and Replication (TIDieR), results of recruitment, and baseline characteristics of the enrolled sample.MethodsThe CHOICE intervention is a multi-contact, extended counseling intervention, based on the Chronic Care Model, shared decision-making, motivational interviewing, and evidence-based options for managing AUDs, designed to be practical in primary care. Outpatients who received care at 3 Veterans Affairs primary care sites in the Pacific Northwest and reported frequent heavy drinking (≥4 drinks/day for women; ≥5 for men) were recruited (2011–2014) into a trial in which half of the participants would be offered additional alcohol-related care from a nurse. CHOICE nurses offered 12 months of patient-centered care, including proactive outreach and engagement, repeated brief motivational interventions, monitoring with and without alcohol biomarkers, medications for AUDs, and/or specialty alcohol treatment as appropriate and per patient preference. A CHOICE nurse practitioner was available to prescribe medications for AUDs.ResultsA total of 304 patients consented to participate in the CHOICE trial. Among consenting participants, 90% were men, the mean age was 51 (range 22–75), and most met DSM-IV criteria for alcohol abuse (14%) or dependence (59%). Many participants also screened positive for tobacco use (44%), depression (45%), anxiety disorders (30-41%) and non-tobacco drug use disorders (19%). At baseline, participants had a median AUDIT score of 18 [Interquartile range (IQR) 14–24] and a median readiness to change drinking score of 5 (IQR 2.75–6.25) on a 1–10 Likert scale.ConclusionThe CHOICE trial tested a patient-centered intervention for AUDs and recruited primary care patients at high risk for AUDs, with a spectrum of severity, co-morbidity, and readiness to change drinking.Trial registration The trial is registered at clinicaltrial.gov (NCT01400581).

Psychopathology and personality traits associated with driving while intoxicated in Beijing, China: Implications for interventions.

Driving while intoxicated (DWI) represents an area of grave concern in China, yet little research has focused on it or on the personality traits and psychiatric disorders among these drivers. We enrolled 325 of 382 residents charged with DWI in a compulsory detention center in Beijing, China. And 351 male drivers who had never had any alcohol arrests as control participants. All were screened for Axis I disorders using the Chinese version of the Structured Clinical Interview for the Diagnostic Statistical Manual of Mental Disorders IV-TR (SCID), the Minnesota Multiphasic Personality Inventory (MMPI-2), and the Sixteen Personality Factor Questionnaire (16PF). The subjects were all males with a mean (±SD) age of 34.41 ± 8.48 years, and almost 30% met DSM-IV criteria for alcohol abuse or dependence (n = 92). Compared to normal controls they showed greater Social Boldness, Abstractedness, Apprehension, Liveliness and Tension, and poorer Reasoning, Vigilance, Openness to Change, and Self-reliance. On the MMPI-2, DWI subjects showed greater Hypochondriasis, Psychopathic Deviate, Paranoia, Psychasthenia, Schizophrenia and Hypomania; and lower Social introversion. Severe alcohol problems are more common in Beijing's drunk drivers than in the Chinese general population. These DWI drivers also have a broad variety of traits that increase their tendency to be venturesome and socially bold while enjoying excitement and risk-taking. (Am J Addict 2017;26:374-378).

A185 - Body Contouring Surgery following Roux-En-Y Gastric Bypass in the Longitudinal Assessment of Bariatric Surgery-2 Cohort

gastric bypass (RYGB) patients become intoxicated remarkably fast and reach peak blood alcohol concentrations that are surprisingly high (Steffen et al., 2013). Additionally, data also suggests that patients are more likely to meet criteria for an alcohol use disorder following RYGB (King et al., 2012). Further, the surgical procedure that patients undergo may have an impact on alcoholrelated outcomes: laparoscopic adjustable band patients appear to be less likely to have problems with alcohol than gastric bypass patients (Ostlund, 2011). Methods: Although we know that patients are at an increased risk for problems with alcohol after surgery, we know very little about the patients who have such problems. The current study aimed to gain a better understanding of patients who report having alcohol problems after surgery. To enter the study participants had to: 1) have received RYGB or Sleeve Gastrectomy surgery in the past 14 years, 2) be 21 years of age or older, and 3) have self-reported problems with alcohol use after surgery. Qualifiers completed a number of paper-and-pencil self-report assessments and interviews, including the Mini International Neuropsychiatric Interview, portions of the Structured Clinical Interview for DSM-IV, and the Alcohol Use Disorder Identification Test. Results: At the time of abstract submission 54 people had been screened and 24 participants qualified and completed the protocol. Participants’ age ranged from 27 to 60 with a mean of 43.9 (SD1⁄410.6 years) and twenty-one (87.5%) of the participants were female.Participants completed the protocol an average of 2.2 years after surgery (SD1⁄41.0). Participants mean score on the AUDIT was 21.9 (SD1⁄46.6) with a range of 12 to 36. Before surgery 18.8% of the sample most frequently drank wine, compared with 37.5% of the sample after surgery.Before surgery 31.3% of the sample reported drinking beer most frequently, compared with 12.5% after surgery. Finally, 37.5% of the sample most often drank liquor before surgery and 43.8% did so after surgery. Based on data from the SCID, in the six months prior to surgery less than ten percent of participants reported abuse of alcohol and none reported dependence. After surgery approximately one-third of the sample reported alcohol abuse and half reported dependence. Conclusion: Based on these findings, it appears that although many of the participants met DSM-IV criteria for alcohol abuse or dependence after surgery, surprisingly few of them reported having significant problems with alcohol in the six months prior to surgery. Also, we found that people report drinking beer as their “drink of choice” less frequently and wine and liquor more frequently after surgery.

DSM-IV and DSM-5 alcohol use disorder among young Swiss men.

Previous studies suggest that the new DSM-5 criteria for alcohol use disorder (AUD) will increase the apparent prevalence of AUD. This study estimates the 12-month prevalence of AUD using both DSM-IV and DSM-5 criteria and compares the characteristics of men in a high risk sample who meet both, only one and neither sets of diagnostic criteria. 5943 Swiss men aged 18-25 years who participated in the Cohort Study on Substance Use Risk Factors (C-SURF), a population-based cohort study recruited from three of the six military recruitment centres in Switzerland (response rate = 79.2%). DSM-IV and DSM-5 criteria, alcohol use patterns, and other substance use were assessed. Approximately 31.7% (30.5-32.8) of individuals met DSM-5 AUD criteria [21.2% mild (20.1-22.2); 10.5% moderate/severe (9.7-11.3)], which was less than the total rate when DSM-IV criteria for alcohol abuse (AA) and alcohol dependence (AD) were combined [36.8% overall (35.5-37.9); 26.6% AA (25.4-27.7); 10.2% AD (9.4-10.9)]. Of 2479 respondents meeting criteria for either diagnoses, 1585 (63.9%) met criteria for both. For those meeting DSM-IV criteria only (n = 598, 24.1%), hazardous use was most prevalent, whereas the criteria larger/longer use than intended and tolerance to alcohol were most prevalent for respondents meeting DSM-5 criteria only (n = 296, 11.9%). Two in five DSM-IV alcohol abuse cases and one-third of DSM-5 mild AUD individuals fulfilled the diagnostic criteria due to the hazardous use criterion. The addition of the craving and excluding of legal criterion, respectively, did not affect estimated AUD prevalence. In a high-risk sample of young Swiss males, prevalence of alcohol use disorder as diagnosed by DSM-5 was slightly lower than prevalence of DSM-IV diagnosis of dependence plus abuse; 63.9% of those who met either criterion met criteria for both.

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.

Functioning of Alcohol Use Disorder Criteria Among Men and Women with Arrests for Driving Under the Influence of Alcohol

Many states require screening of individuals arrested for driving under the influence (DUI) of alcohol to determine recidivism risk and the need for treatment based on severity of alcohol problems. Several screening instruments use DSM-IV criteria for alcohol abuse and dependence to assess alcohol problems in this population, but whether they adequately measure alcohol problems in individuals with DUIs has not been examined. In addition, gender differences in DUI samples suggest that female offenders have more severe alcohol problems than male offenders. The current study examines differences in alcohol criteria functioning by DUI history and gender using an item response theory (IRT) approach. Data from diagnostic interviews with 8,605 participants in the Collaborative Study on the Genetics of Alcoholism, including 1,655 who ever reported a DUI arrest (20% women), were used to examine differences in alcohol criteria functioning between men and women with and without DUIs. The factor underlying item response was conceptualized as unidimensional, representing alcohol problem severity. Social/interpersonal problems, larger/longer, and inability/persistent desire to quit displayed greater discrimination of IRT-defined alcohol problem severity among individuals with DUIs than those without. Irrespective of DUI status, women had a higher threshold than men for time spent drinking or recovering. Women without DUIs had a higher threshold than similar men for social/interpersonal problems. Taken as a whole, the criteria yielded similar amounts of information in all groups. DSM-IV criteria for alcohol abuse and dependence adequately detect alcohol problem severity in individuals with DUIs, and some are better at detecting severity in this particularly high-risk group than in individuals without DUIs. However, the criteria as a whole are equally effective in measuring alcohol problem severity among individuals with and without DUIs and may be used with confidence in screening DUI offenders.

Depression, alcohol abuse, and disclosure of HIV serostatus among rural HIV-positive individuals in western Uganda

Depression, alcohol abuse, and disclosure of HIV serostatus among rural HIV-positive individuals in western Uganda E Nakimuli-Mpungu1,2, G Munyaneza3,41Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 2Department of Psychiatry, Makerere College of Health Sciences, School of Medicine, Kampala, Uganda; 3Butabika School of Psychiatric Clinical Officers, Ministry of Education, Kampala, Uganda; 4Rushere Community Hospital, Rushere, UgandaIntroduction: Research into psychological factors associated with disclosure of human immunodeficiency virus (HIV) serostatus in low resource settings is limited. The primary aim of this study was to determine the relationship between depression, alcohol abuse, and disclosure of HIV serostatus to social networks.Methods: We performed a cross-sectional study in which 244 HIV-positive individuals were examined for disclosure of HIV-positive serostatus and assessed for DSM-IV (Diagnostic Statistical Manual, fourth edition)-defined major depression and alcohol abuse disorder. Multiple regression models were used to determine factors independently associated with major depression, alcohol abuse, and disclosure of HIV serostatus.Results: Of the 244 study participants, the majority 210 (86%) had disclosed their HIV serostatus. Among those who disclosed their HIV serostatus, 48 (23%) regretted this disclosure. The majority (40%) met DSM-IV criteria for depression, while (7.8%) met DSM-IV criteria for alcohol abuse. Disclosure was protective against alcohol abuse (odds ratio [OR] = 0.21; P = 0.016) but not depression (OR = 0.68; P = 0.38); and was associated with time since HIV diagnosis (OR = 1.39; P = 0.007) and HIV pretest counseling (OR = 3.9; P = 0.045).Conclusion: Disclosure of HIV serostatus was protective against alcohol abuse but not depression, while regret of disclosure was significantly associated with depression.Keywords: alcohol abuse, HIVstatus, depression, disclosure

Alcohol Biomarkers in Patients Admitted for Trauma

To assess the value of blood alcohol levels (BAL) and carbohydrate-deficient transferrin (CDT) in trauma patients. A prospective study was conducted among 213 patients admitted to a university hospital after trauma. Outcomes of interest included the development of alcohol withdrawal, infections, respiratory problems, cardiac events, thromboembolism, and length of stay. The majority (78%) of the trauma patients in the study was males over the age of 18. Seventy-five percent were reported drinking an alcohol-containing beverage in the previous 30 days, 34% had > or =5 heavy drinking days, and 18.7% met current DSM-IV criteria for alcohol abuse and 13.1% current criteria for dependence. Twenty-two percent (n = 48) had a positive BAL and 14% (n = 30) a CDT level >2.5%. Twelve percent (n = 27) of the sample developed alcohol withdrawal and 55% (n = 113) had one or more adverse health events during their hospitalization. The development of alcohol withdrawal was associated with an admission CDT >2.5% (chi(2): 4.77, p < 0.029) and/or a positive BAL (chi(2): 54.01, p < 0.001). The alcohol biomarkers identified 13 male and 3 female high-risk patients (7.4% of the total sample) who denied excessive alcohol use, and who would have been missed if these markers were not used. A composite morbidity trauma score composed of 25 adverse health events was associated with a positive BAL (p < 0.022). The study provides additional empirical evidence that supports the use of BAL in all patients admitted for trauma. The usefulness of CDT in trauma patients remains unclear and will require larger samples in more critically ill patients.

A taxometric study of alcohol abuse and dependence in a general population sample: evidence of dimensional latent structure and implications for DSM-V

To explore, with the aid of taxometric analysis, whether alcohol abuse and alcohol dependence are each conceptualized most effectively as single latent dimensions or distinct latent categories. Data were taken from a nationally representative cross-sectional epidemiological survey of psychiatric and substance use disorders. General population of Australia. A subsample of all respondents who had consumed at least 12 drinks in the year prior to the survey and who had consumed at least three drinks on at least one single day (n = 4920 of a possible 10,641). DSM-IV criteria for alcohol abuse and dependence were assessed with the Composite International Diagnostic Interview, version 2.1. Two independent taxometric procedures, MAXimum EIGenvalue (MAXEIG) and mean above minus below a cut (MAMBAC), together with analysis of simulated dimensional and categorical data sets, were carried out. Findings Consistent evidence was found for a single latent dimension underlying the symptoms of alcohol dependence. Less consistent evidence of dimensionality was found for the symptoms of alcohol abuse. These findings support the growing consensus regarding the need for continuous measures of alcohol use disorders to complement the traditional categorical representations in upcoming versions of the major psychiatric classification systems.

Assessing criterion validity of the Simple Screening Instrument for Alcohol and Other Drug Abuse (SSI-AOD) in a college population

Heavy drinking among college students is widespread, characterized by a unique pattern of heavy episodic drinking, and carries risk of negative consequences both immediate and long term. Because screening to detect high-risk student drinkers is of primary importance to insure early identification and appropriate levels of care, this study evaluated the criterion validity of the SSI-AOD. The SSI-AOD evidenced moderate to strong correlations with alcohol frequency, consumption, and problem indices. Sensitivity and specificity of the SSI-AOD and the AUDIT was determined by ROC analysis utilizing a range of possible cut-off scores using DSM-IV criteria for alcohol abuse as the reference standard. The SSI-AOD had very low sensitivity at the recommended cut-score of 4 and demonstrated poor ability to correctly classify participants overall. The AUDIT demonstrated significantly better performance, correctly classifying approximately 70% of participants using a cut-score of 8.

Reclassifying DIS-III-R Alcohol Use Disorders to DSM-IV Criteria in a Sample of Convicted Impaired Drivers

This study used data gathered from the Diagnostic Interview Schedule, Version Three, Revised (DIS-III-R), which calculated diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), criteria and rescored the data to be compatible with the criteria of the Fourth Edition of the DSM (DSM-IV) for lifetime alcohol abuse and dependence. A psychologist reassigned questions from the DIS-III-R according to DSM-IV criteria. Another clinician evaluated the rescoring criteria and discrepancies were discussed and resolved. Using these criteria, SAS code was written to automate the rescoring of responses to DIS-III-R questions to DSM-IV diagnoses from a population of DWI offenders. There was a fair-to-good level of agreement between the DSM-III-R and rescored DSM-IV diagnoses (kappa = .65). Three hundred forty-eight subjects classified as alcohol dependent using DSMIII- R were reclassified as alcohol abuse in the DSM-IV rescore. Among subjects who were alcohol dependent based on DIS-III-R criteria, the distribution of DSM-IV diagnoses was similar across gender, age, and ethnic groups. There was no difference in agreement between DSMIII- R and the rescored DSM-IV diagnoses by age category. However, women and Hispanics had significantly higher weighted kappa statistics than men and non-Hispanic whites. Our rescoring results were consistent with earlier studies that compared DSM-III-R and DSM-IV diagnoses. Here, we offer an approach that may be useful to investigators who used the DIS-III-R in earlier studies. The DIS-III-R questions corresponding to DSM-IV criteria for alcohol abuse and alcohol dependence are on our Web site at www.bhrcs.org, along with the scoring algorithm.

Fast Alcohol Consumption Evaluation: A Screening Instrument Adapted for French General Practitioners

To meet the needs of French general practitioners (GPs), we created a short (5 questions) interview/screening test for alcohol-related problems that is similar to AUDIT in terms of (1) test values and (2) identification of 3 groups: (a) abstainers and low-risk drinkers; (b) heavy drinkers; and (c) alcohol abusers or showing dependence. Nine questions (from AUDIT, CAGE, TWEAK, Five-shot Questionnaire) were given systematically to their patients (aged 18 or more) by 41 volunteer GPs. Before the consultation, patients confidentially completed the AUDIT questionnaire in the waiting room. After the consultation, an addiction specialist evaluated each patient's alcohol consumption and DSM-IV criteria for alcohol abuse and dependence and these were used as gold standards. The analysis included 564 patient records and used stepwise logistic regression to select 7 questions, from which a second selection resulted in a 5-item questionnaire. These questions are: AUDIT questions 1 (Frequency) and 2 (Usual quantity), CAGE questions 2 (Annoyed) and 4 (Eye-opener), and TWEAK question 5 (Black-out), with each question scored 0 to 4. High levels of sensitivity and specificity were obtained for each diagnosis (sensitivity 75%-87.8%; specificity 74%-95.8%). FACE is an appropriate screening method for French general practitioners.

Aripiprazole Therapy for Nicotine Dependence

Aripiprazole Therapy for Nicotine Dependence

Prospective Evaluation of the Four DSM-IV Criteria for Alcohol Abuse in a Large Population

In 1994 DSM-IV presented new criteria for substance abuse as repetitive problems in any one of four areas reflecting social, interpersonal, and legal difficulties. The authors systematically evaluate the performance of each of the four diagnostic criteria for alcohol abuse (problems in role functioning, alcohol use in hazardous situations, alcohol-related legal problems, and social or interpersonal problems) and determine the prognosis associated with a threshold of one versus two or more criterion endorsements. Baseline and 5-year follow-up data were analyzed for 2,596 men and women from the Collaborative Study on the Genetics of Alcoholism, including 1,881 individuals with no alcohol-related diagnosis, and 715 with alcohol abuse, after excluding subjects with alcohol dependence. Performance of each criterion was analyzed for the entire group and for the 565 individuals who endorsed only one criterion at baseline. One alcohol abuse criterion was endorsed by 79% of subjects with alcohol abuse, 18.5% endorsed two, and 2.5% endorsed three. Compared with subjects who endorsed no criteria, individuals who reported any of the four diagnostic criteria at baseline had higher rates of alcohol and drug intake and related problems and higher rates of future difficulties. Diagnostic thresholds of one versus two abuse criteria at baseline performed equally well regarding most outcomes, although endorsement of two criteria predicted a higher risk for progression to dependence. The criterion most frequently endorsed--hazardous use--was associated with baseline substance use characteristics and problematic outcomes similar to those for the other criteria. The four DSM-IV alcohol abuse criteria performed well regarding both cross-sectional characteristics and the prediction of future problems, but no single diagnostic criterion was superior to any other. The similarity of outcomes for subjects with diagnostic thresholds of one versus two or more criteria may favor the continued use of a threshold of one criterion in the diagnosis of alcohol abuse.

Diagnostic orphans: adolescents with alcohol symptom who do not qualify for DSM-IV abuse or dependence diagnoses.

Little is known about the validity of the DSM-IV criteria for alcohol use disorders when applied to adolescents. This report describes a group of "diagnostic orphans," adolescents with one or two DSM-IV alcohol dependence symptoms who do not meet the DSM-IV criteria for alcohol abuse or alcohol dependence. The study included 199 male and 173 female subjects aged 13-19 years. All subjects were regular drinkers, recruited from community sources and alcohol treatment programs. At baseline and at 1-year follow-up, DSM-IV alcohol use disorders were assessed with a version of the Structured Clinical Interview for DSM-III-R, modified for DSM-IV criteria. Diagnostic orphans represented 31% of the drinkers without an alcohol use disorder. The orphans were similar to the alcohol abusers and dissimilar to the other drinkers in alcohol and substance use patterns and in the course of alcohol problems over 1 year. The results indicate limitations of the DSM-IV criteria for alcohol use disorders when applied to adolescents. Diagnostic orphans should be considered separately from other drinkers in research and treatment efforts.

Gender differences in the probability of alcohol treatment.

Interview data from 7,359 adults 18 years of age and over who met the DSM-IV criteria for alcohol abuse or dependence at some point during their lives revealed that 23.0% of the men and 15.1% of the women ever received treatment for alcohol problems. The median interval from onset of disorder to first treatment was between 2 and 3 years longer for men than women. This difference did not result from women being more likely than men to initiate treatment shortly after onset of an alcohol use disorder, but rather from men being more likely than women to initiate treatment in the period well after onset. Excluding treatment initiated prior to the clinical onset of the disorders or after cessation of drinking, men's and women's cumulative conditional probabilities of having initiated treatment by 30 years after onset of alcohol abuse or dependence were .424 and .356, respectively. Within the first 8 years after onset of abuse or dependence, men's and women's probabilities of initiating treatment were about the same, but men were 13% to 20% more likely to initiate treatment in the period from 8 to 25 years after onset. Use of proportional hazards models to adjust for factors including sociodemographic characteristics, prior consumption, severity of disorder, and comorbid drug use and depression revealed that men's and women's likelihoods of ever having received treatment did not differ for the most severely affected, those with 20 or more symptoms of abuse or dependence. Among those less severely affected, the male-to-female ratio in the likelihood of treatment declined with severity from 1.75 (1 symptom) to 1.24 (15 symptoms).