title: Case ascertainment of alcohol dependence in general population surveys: 'gated' versus 'ungated' approaches.
abstract: Social role impairment and other forms of maladaptation are referenced explicitly in the case definitions for the drug use disorders within DSM-IV-TR, but there is continuing debate about whether and how to include these manifestations of 'clinical significance' in diagnostic criteria and assessment protocols. When a 'gated' approach (based on impairment or other maladaptation) has been taken during recent large scale psychiatric surveys with coverage of drug dependence (e.g. to reduce participant fatigue or burden), the net effect may include (a) a reduced number of identified cases, and (b) biases in the estimates of association linked to the occurrence of drug dependence. In this report focused on alcohol dependence, we probe these issues, making use of data from the cross-sectional US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a household survey with 44,093 adult participants. NESARC alcohol dependence assessments were 'ungated', but allowed simulation of a 'gated' approach; the end result was a robust decrement in the estimated prevalence of this condition. Nonetheless, patterns of association linking suspected background characteristics to prevalence of alcohol dependence were not appreciably different when the gated and ungated estimates were contrasted. In summary, there are reasons to take the ungated approach in detailed research on alcohol use and dependence. Nevertheless, in panoramic mental health surveys, the inefficiency of an ungated approach must be balanced against the anticipated yield of cases who have experienced alcohol dependence without alcohol related social role impairments or other maladaptation, particularly when the dependence syndromes without these consequences are sometimes thought to lack clinical significance.
authors: Department of Epidemiology, Michigan State University, East Lansing, MI 48824, USA.
authors: Louisa
authors: L
authors: Degenhardt
authors: Kipling M
authors: KM
authors: Bohnert
authors: James C
authors: JC
authors: Anthony
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011795:Surveys and Questionnaires
references: Arch Gen Psychiatry. 1998 Dec;55(12):1145; author reply 1147-8
references: 9862559
references: Arch Gen Psychiatry. 2004 Aug;61(8):807-16
references: 15289279
references: Arch Gen Psychiatry. 1977 Sep;34(9):1012-22
references: 901133
references: Am J Epidemiol. 1998 Dec 15;148(12):1168-74
references: 9867262
references: Arch Gen Psychiatry. 1998 Feb;55(2):109-15
references: 9477922
references: Arch Gen Psychiatry. 2004 Dec;61(12):1188-94
references: 15583110
references: Q J Stud Alcohol. 1946 Jun;7:1-88
references: 20989144
references: Addiction. 1999 Oct;94(10):1541-50
references: 10790906
references: Arch Gen Psychiatry. 2000 Mar;57(3):227-8
references: 10711908
references: Aust N Z J Psychiatry. 2000 Apr;34(2):206-13
references: 10789525
references: Arch Gen Psychiatry. 1998 Feb;55(2):120
references: 9477924
references: Br Med J. 1976 May 1;1(6017):1058-61
references: 773501
references: J Epidemiol Community Health. 2003 Nov;57(11):893-900
references: 14600117
references: Arch Gen Psychiatry. 1981 Apr;38(4):381-9
references: 6260053
references: Arch Gen Psychiatry. 1998 Feb;55(2):119
references: 9477923
references: Aust N Z J Psychiatry. 2006 Oct;40(10):830-4
references: 16959008
references: Int J Methods Psychiatr Res. 2007;16(2):43-51
references: 17623384
references: Neuropsychopharmacology. 2002 Apr;26(4):479-88
references: 11927172
references: Arch Gen Psychiatry. 2004 Dec;61(12):1197-207
references: 15583111
references: Am J Psychiatry. 1970 Jan;126(7):983-7
references: 5409569
references: Subst Use Misuse. 2000 May-Jun;35(6-8):1051-73
references: 10847222
references: Arch Gen Psychiatry. 2002 Feb;59(2):115-23
references: 11825131
references: Biometrics. 1946 Jun;2(3):47-53
references: 21001024