The craving withdrawal model for alcoholism: towards the DSM-V. Improving the discriminant validity of alcohol use disorder diagnosis.
OBJECTIVE
To compare the discriminant validity of the DSM-IV and the ICD-10 classification of alcohol use disorders (AUD) with an alternative classification, the craving withdrawal model (CWM). CWM requires craving and withdrawal for the diagnosis of alcohol dependence and raises the alcohol abuse threshold to two DSM-IV AUD criteria.


METHODS
Data were derived from The Netherlands Mental Health Survey and Incidence Study, a large representative sample of the general Dutch population. In the present study, only non-abstinent subjects were included (n=6041). Three diagnostic systems (DSM-IV, ICD-10, and CWM) were compared using the following discriminant variables: alcohol intake, psychiatric comorbidity, functional status, familial alcohol problems, and treatment sought.


RESULTS
The year prevalence of CWM alcohol dependence was lower than the prevalence of ICD-10 and DSM-IV dependence (0.3% vs 1.4% and 1.4%). The year prevalence of abuse was similar for CWM and DSM-IV (4.7 and 4.9%), but lower for ICD-10 harmful use (1.7%). DSM-IV resulted in a poor distinction between normality and abuse and ICD-10 resulted in a poor distinction between harmful use and dependence. In contrast, the CWM distinctions between normality and abuse, and between abuse, and dependence were significant for most of the discriminant variables.


CONCLUSIONS
This study indicates that CWM improves the discriminant validity of AUD diagnoses. The predictive validity of the CWM for alcohol and other substance use disorders remain to be studied.
de Bruijn
Carla
C
Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands. h.debruijn-2@psych.azu.nl
van den Brink
Wim
W
de Graaf
Ron
R
Vollebergh
Wilma A M
WA
D000328:Adult; D019973:Alcohol-Related Disorders / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D000437:Alcoholism / Q000145:classification* / Q000175:diagnosis* / Q000523:psychology; D016739:Behavior, Addictive / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D016002:Discriminant Analysis; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D008297:Male; D008960:Models, Psychological; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011594:Psychometrics; D015203:Reproducibility of Results; D013375:Substance Withdrawal Syndrome / Q000145:classification / Q000175:diagnosis* / Q000523:psychology
D000431:Ethanol