The factor structure and severity of DSM-IV alcohol abuse and dependence symptoms in psychiatric outpatients.
OBJECTIVE
The goal of the present study was to examine the factor structure and estimated severity of alcohol-use disorder (AUD) symptoms in a sample of treatment-seeking psychiatric outpatients.


METHODS
Participants (n = 1,027; 51.2% women) met the screening criteria for the lifetime assessment of AUDs according to the Structured Clinical Interview for the DSM-IV (SCID-I/P; First et al., 1995) and as a result completed an assessment of alcohol abuse and dependence symptoms. The average (SD) age of the sample was 36.6 (11.4) years, and 71% of participants met lifetime DSM-IV criteria for an AUD.


RESULTS
Exploratory factor analysis of the tetrachoric correlation matrix of alcohol abuse and dependence criteria revealed that a single factor best accounted for the data in this sample. Results of Rasch model analyses indicated that the severity ordering of the DSM-IV abuse and dependence symptoms was not consistent with the hierarchical structure suggested by the DSM-IV. Instead, abuse items were found to be spread across a full range of the AUD continuum and were not consistently in the lower ranges of severity.


CONCLUSIONS
This study extends the literature by examining a treatment-seeking psychiatric outpatient sample and using a semistructured diagnostic interview administered by mental health professionals. Methodological considerations and implications for the conceptualization of AUD are discussed.
Ray
Lara A
LA
Center for Alcohol and Addiction Studies, Box G-S121-4, Brown University, Providence, Rhode Island 02912, USA. Lara_Ray@Brown.edu
Kahler
Christopher W
CW
Young
Diane
D
Chelminski
Iwona
I
Zimmerman
Mark
M
D000328:Adult; D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012237:Rhode Island