What were they thinking? Adolescents' interpretations of DSM-IV alcohol dependence symptom queries and implications for diagnostic validity.
OBJECTIVE
DSM-IV alcohol dependence criteria of tolerance to alcohol and drinking more or longer than intended have relatively high prevalence among youth, and may be vulnerable to false positive symptom assignments that degrade diagnostic validity. We conducted a methodological study of DSM-IV symptom queries used to assess alcohol tolerance and impaired control over drinking to determine potential sources of measurement error.


METHODS
Adolescents recruited from addictions treatment participated in either a focus group (n = 9) or an individual interview (n = 41) to provide data on their interpretation of selected items contained in a semi-structured diagnostic interview.


RESULTS
When alcohol tolerance is operationally defined as a change in quantity to obtain the same effect, large individual differences in the change in quantity that represents a high level of tolerance limit the utility of this operational definition as an indicator of dependence. The symptom "drinking more or longer than intended", includes the embedded assumption that a limit on use had been set. Teens, however, typically intended to become intoxicated, rather than to keep to a limit.


CONCLUSIONS
Adolescents' understanding of symptom queries suggests how validity of DSM-IV alcohol symptoms and diagnoses can be improved through greater attention to developmental considerations affecting assessment.
Chung
Tammy
T
Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh Adolescent Alcohol Research Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. chungta@upmc.edu
Martin
Christopher S
CS
D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000175:diagnosis*; D001294:Attitude to Health; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004361:Drug Tolerance; D000431:Ethanol / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012720:Severity of Illness Index
D000431:Ethanol