The role of alcohol consumption in future classifications of alcohol use disorders.
BACKGROUND
Item response theory (IRT) was used to determine whether DSM-IV alcohol abuse and dependence and consumption criteria were arrayed along a continuum of severity.


METHODS
Data came from a large, nationally representative sample of the U.S. adult population.


RESULTS
DSM-IV alcohol abuse and dependence criteria formed a continuum of alcohol use disorder severity along with the drinking 5+/4+ at least once a week in the past year criterion. Criteria were invariant across sex, race-ethnicity, and age subgroups.


CONCLUSIONS
The drinking 5+/4+ high-risk drinking pattern was identified as a suitable criterion for future classifications of DSM-IV alcohol use disorder. Some dependence criteria were among the least severe criteria, and some abuse criteria were among the most severe, findings that question the validity of DSM-IV abuse and dependence categories as distinct entities and that do not support the assumption of abuse as prodromal to dependence. Physical dependence and addiction were identified as defining elements of the continuum. Further research examining their dimensional properties and relationships to high-risk drinking patterns appears warranted. An approach highlighting a more important role of consumption in future classifications of alcohol use disorder defined broadly to encompass all alcohol-related harm, including addiction and physical dependence, is discussed.
Saha
Tulshi D
TD
Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9304, United States.
Stinson
Frederick S
FS
Grant
Bridget F
BF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D019973:Alcohol-Related Disorders / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology; D000437:Alcoholism / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment / Q000706:statistics & numerical data; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D014481:United States