title: A test of the DSM-5 severity scale for alcohol use disorder.
abstract: BACKGROUND
  For the DSM-5-defined alcohol use disorder (AUD) diagnosis, a tri-categorized scale that designates mild, moderate, and severe AUD was selected over a fully dimensional scale to represent AUD severity. The purpose of this study was to test whether the DSM-5-defined AUD severity measure was as proficient a predictor of alcohol use following a brief intervention, compared to a fully dimensional scale.
  
  
  METHODS
  Heavy drinking primary care patients (N=246) received a physician-delivered brief intervention (BI), and then reported daily alcohol consumption for six months using an Interactive Voice Response (IVR) system. The dimensional AUD measure we constructed was a summation of all AUD criteria met at baseline (mean=6.5; SD=2.5). A multi-model inference technique was used to determine whether the DSM-5 tri-categorized severity measure or a dimensional approach would provide a more precise prediction of change in weekly alcohol consumption following a BI.
  
  
  RESULTS
  The Akaike information criterion (AIC) for the dimensional AUD model (AIC=7623.88) was four points lower than the tri-categorized model (AIC=7627.88) and weight of evidence calculations indicated there was 88% likelihood the dimensional model was the better approximating model. The dimensional model significantly predicted change in alcohol consumption (p=.04) whereas the DSM-5 tri-categorized model did not.
  
  
  CONCLUSIONS
  A dimensional AUD measure was superior, detecting treatment effects that were not apparent with tri-categorized severity model as defined by the DSM-5. We recommend using a dimensional measure for determining AUD severity.
authors.affiliation: Department of Psychology, University of Vermont, 2 Colchester Avenue, Burlington, VT 05401, USA; Department of Psychiatry, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, USA. Electronic address: tfazzino@uvm.edu.
authors.forename: Tera L
authors.initials: TL
authors.lastname: Fazzino
authors.affiliation: Department of Psychiatry, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, USA.
authors.forename: Gail L
authors.initials: GL
authors.lastname: Rose
authors.affiliation: Department of Psychology, University of Vermont, 2 Colchester Avenue, Burlington, VT 05401, USA.
authors.forename: Keith B
authors.initials: KB
authors.lastname: Burt
authors.affiliation: Department of Psychiatry, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Helzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019973:Alcohol-Related Disorders / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Alcohol use disorder; Alcohol use disorder severity; DSM-5; Diagnosis; Dimensional; Multi-model inference