title: Threshold and optimal cut-points for alcohol use disorders among patients in the emergency department.
abstract: BACKGROUND
  Current research suggests that Diagnostic and Statistical Manual of Mental Disorder (DSM)-IV alcohol abuse and dependence form a unidimensional continuum in emergency department (ED) patients in 4 countries: Argentina, Mexico, Poland, and the United States. In this continuum of alcohol use disorder (AUD), there are no clear-cut distinctions between the criteria for dependence and abuse in the severity dimension based on prior results from item response theory (IRT) analysis. Nevertheless, it is desirable to find a threshold for identifying cases for clinical practice and cut-points of clinical utility in this continuum to distinguish between patients more or less affected by an AUD, using a scale of symptoms count.
  
  
  METHODS
  Data from 5,193 patients in 7 ED sites in the same 4 countries (3,191 current drinkers) were used to study the structure, threshold, and possible cut-points for the diagnoses of AUD.
  
  
  RESULTS
  The proposed changes in the DSM-V, dropping the abuse item "legal problems" and adding an item on "craving," did not impact the IRT performance and unidimensionality of AUD in this sample. With a total set of 11 items (deleting "legal problems" and adding "craving" to the current set of DSM criteria), an endorsement of 2 or more criteria can be used as the threshold to define those with an AUD in clinical practice. Furthermore, we can distinguish at least 2 levels of clinical severity, 2 to 3 criteria (moderate), and 4 or more criteria (severe).
  
  
  CONCLUSIONS
  A dimensional approach to AUD using the proposed new set of criteria for the DSM-V can be used to propose a threshold and levels of severity. More research in different populations and countries is needed to further substantiate a threshold and cut-points that could be used in new formulations of substance use disorders.
authors.affiliation: National Institute of Psychiatry, Calzada Mexico Xochimilco No. 101, Col. San Lorenzo Huipulco, Mexico City, Mexico. guibor@imp.edu.mx
authors.forename: Guilherme
authors.initials: G
authors.lastname: Borges
authors.forename: Cheryl J
authors.initials: CJ
authors.lastname: Cherpitel
authors.forename: Yu
authors.initials: Y
authors.lastname: Ye
authors.forename: Jason
authors.initials: J
authors.lastname: Bond
authors.forename: Mariana
authors.initials: M
authors.lastname: Cremonte
authors.forename: Jacek
authors.initials: J
authors.lastname: Moskalewicz
authors.forename: Grazyna
authors.initials: G
authors.lastname: Swiatkiewicz
mesh_terms: D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D016208:Databases, Factual / Q000592:standards; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results