The dimensionality of alcohol abuse and dependence: a multivariate analysis of DSM-IV symptom items in the National Longitudinal Survey of Youth.
OBJECTIVE
This article examines the factor structure of 22 symptom items used to configure the criteria of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) alcohol abuse and dependence and relates the factor structure to background characteristics.


METHODS
Data for this study were drawn from the National Longitudinal Study of Labor Market Experience in Youth (NLSY). The symptom items were related to the covariates using the statistical technique of structural equation modeling generalized to dichotomous outcomes. The present model is a special case of structural equation modeling, a multiple causes and multiple indicators (MIMIC) model, in which one or more latent variables (i.e., alcohol abuse and dependence) intervene between a set of observed background variables predicting a set of observed response variables (i.e., DSM-IV symptom items).


RESULTS
The results of the structural equation analysis provide further support for two dimensions underlying the DSM-IV symptom items. Although the two-factor dimension bore a strong resemblance to the DSM-IV conceptions of abuse and dependence, there were notable differences in the item content of the symptom items for each dimension. The dependence dimension drew upon items related to the abuse criteria for continued drinking despite social problems and recurrent drinking resulting in failure to fulfill role obligations. The abuse dimension drew upon items related to the abuse criterion for hazardous drinking and the dependence criterion for larger amounts over time. The two factors were shown to have different relationships to the background variables. Alcohol dependence was related to family history of alcoholism and educational status. Age was not related to dependence and inversely related to alcohol abuse.


CONCLUSIONS
Findings from this study replicate the two-dimensional model for DSM-IV criteria found in other studies and provide further support for the validity of alcohol dependence in general population samples. A major implication of the factor structure in the present study relates to the different classification of cases that would otherwise be obtained with DSM-IV criteria. These departures were shown to affect abuse, which retained only 40% of DSM-IV diagnoses, more strongly than dependence, which retained 91% of DSM-IV diagnoses.
Harford
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TC
Department of Social and Behavioral Sciences, School of Public Health, Boston University, Massachusetts, USA.
Muthén
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D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D016009:Chi-Square Distribution; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors