The dimensionality of alcohol use disorders: results from Israel.
OBJECTIVE
To prepare for DSM-V, the structure of DSM-IV alcohol dependence and abuse criteria and a proposed additional criterion, at-risk drinking, require study in countries with low per-capita consumption, and comparison of current and lifetime results within the same sample. We investigated DSM-IV Alcohol Use Disorder (AUD) criteria in Israel, where per-capita alcohol consumption is low.


METHODS
Household residents selected from the Israeli population register (N=1338) were interviewed with the AUDADIS. Item response theory analyses were conducted using MPlus, and diagnostic thresholds were examined with the kappa statistic.


RESULTS
Dependence and abuse criteria fit a unidimensional model interspersed across the severity continuum, for both current and lifetime timeframes. Legal problems were rare and did not improve model fit. Weekly at-risk drinking reflected greater severity than in U.S. samples. When dependence and abuse criteria were combined, a diagnostic threshold of > or =3 criteria produced the best agreement with DSM-IV diagnoses (kappa>0.80).


CONCLUSIONS
Consistent with other studies, alcohol dependence and abuse criteria reflected a latent variable representing a single AUD. Results suggested little effect in removing legal problems and little gained by adding weekly at-risk drinking. Results contribute to knowledge about AUD criteria by examining them in a low-consumption country.
New York State Psychiatric Institute, New York, NY 10032, USA.
Dvora
D
Shmulewitz
Katherine
K
Keyes
Cheryl
C
Beseler
Efrat
E
Aharonovich
Christina
C
Aivadyan
Baruch
B
Spivak
Deborah
D
Hasin
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology*; D003625:Data Collection; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence