The validity of DSM-IV alcohol dependence: What do we know and what do we need to know?

Mailman School of Public Health, Division of Epidemiology, and College of Physicians and Surgeons, Department of Psychiatry of Columbia University, New York, NY 10032, USA.
Alcoholism Clinical and Experimental Research (Impact Factor: 3.21). 03/2003; 27(2):244-52. DOI: 10.1097/01.ALC.0000060878.61384.ED
Source: PubMed


This article presents the proceedings of a symposium at the 2002 RSA Meeting in San Francisco, California. Deborah S. Hasin organized the symposium and co-chaired it with Marc Schuckit. The purpose of the symposium was to provide an overview of what is known about the validity of DSM-IV and ICD-10 alcohol dependence and abuse, with a focus on work done since 1994. Presentations included: (1) Validity of DSM-III-R alcohol dependence in adolescents, by Christopher S. Martin; (2) Reliability and validity of DSM and ICD formulations of alcohol use disorders: findings from epidemiology, by Bridget F. Grant; (3) Validity and reliability of the alcohol-dependence phenotype in the context of genetic studies, by Kathleen K. Bucholz; and (4) DSM-IV and beyond: uniting the clinical utility of categories with the precision of dimensions, by John E. Helzer. The findings supported the validity of DSM-IV alcohol dependence across numerous study designs and samples, suggested some value in a dimensional dependence measure, and raised questions about the validity of the diagnosis of alcohol abuse as currently defined. Marc Schuckit, as discussant for the symposium, placed the issues in perspective for the upcoming DSM-V.

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    • "The test–retest reliability for AUDADIS-IV mood, anxiety, and personality diagnoses in the general population and in clinical settings was fair to good (K = 0.40–0.62; Hasin et al., 2003). Measures of the clinical course of CUD included age at first use of cannabis, age of onset at heavy use (defined as daily use or use in more than 20 days/month), age at onset of the CUD, total number of episodes of the CUD, total number of diagnostic criteria met, duration of the longest episode, the percentage of individuals who remitted from the disorder, and the age at remission. "
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    ABSTRACT: Background: To examine gender differences among individuals diagnosed with DSM-IV lifetime cannabis use disorder (CUD). Methods: A nationally representative sample of U.S. adults aged 18 years or older that were diagnosed with lifetime CUD (n=3297): Men (n=2080), Women (n=1217). Data were drawn from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n=43,093). The survey response rate was 81%. Results: Nearly all individuals with CUD had a psychiatric comorbidity (95.6% of men, 94.1% of women). Men with lifetime CUD were more likely than women to be diagnosed with any psychiatric disorder, any substance use disorder and antisocial personality disorder, whereas women with CUD had more mood and anxiety disorders. After adjusting for gender differences in sociodemographic correlates and the prevalence of psychiatric disorders in the general population, women with CUD were at greater risk for externalizing disorders. Men with CUD met more criteria for cannabis abuse, had longer episodes of CUD, smoked more joints, and were older at remission when compared to women with CUD. Women experienced telescoping to CUD. Treatment-seeking rates were very low for both genders, and there were no gender differences in types of services used or reasons for not seeking treatment. Conclusions: There are important gender differences in the clinical characteristics and psychiatric comorbidities among individuals with CUD.
    Drug and alcohol dependence 11/2012; 130(1-3). DOI:10.1016/j.drugalcdep.2012.10.015 · 3.42 Impact Factor
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    • "2.2. DSM-IV psychiatric disorders The diagnostic interview was the Alcohol Use Disorder and Associated Disabilities Interview Schedule e DSM-IV Version (AUDADIS-IV) (Hasin et al., 2003 "
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    ABSTRACT: The authors' objective was to examine the relationship between degree of acculturation across five different dimensions of acculturation and risk of drug use disorders (DUD) among US Hispanics. Data were derived from a large national sample of the US adult population, the National Epidemiological Survey on Alcohol and Related Conditions, collected using face-to-face interviews. The sample included civilian non-institutionalized U.S. population aged 18 years and older, with oversampling of Hispanics, Blacks and those aged 18-24 years. Interviews of more than 34,000 adults were conducted during 2004-2005 using the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV Version. A total of 6359 subjects who identified themselves as Hispanics were included in this study. Acculturation measures used in this study assessed:, time spent in the U.S., age at immigration, language preference, social network composition, and ethnic identification. Among Hispanics, there was an inverse relationship between five complementary dimensions of acculturation and DUD. Moreover, this relationship showed a significant gradient across all acculturation dimensions and DUD. The prevalence of DUD increases with acculturation in Hispanics, across several measures of acculturation in a dose-response relationship. Hispanic cultural features and values exert a protective effect on risk of DUD. Preservation and promotion of Hispanic values may be an important component of preventive interventions for Hispanics.
    Journal of Psychiatric Research 11/2012; 47(2). DOI:10.1016/j.jpsychires.2012.09.019 · 3.96 Impact Factor
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    • "test-retest reliability of AUDADIS-IV substance use diagnoses is documented in clinical and general population samples [56] [57]. Convergent, discriminant, and construct validities of AUDADIS-IV SUD criteria and diagnoses were good to excellent [58] [59]. Mood disorders included DSM-IV major depressive disorder (MDD), bipolar I and II, and dysthymia. "
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    ABSTRACT: Background: This study examines the prevalence, correlates, and psychiatric disorders of adults with history of child sexual abuse (CSA). Methods: Data were derived from a large national sample of the US population. More than 34000 adults 18 years and older residing in households were interviewed face-to-face in a survey conducted during the 2004-2005 period. Diagnoses were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, version. Weighted means, frequencies, and odds ratios of sociodemographic correlates and prevalence of psychiatric disorders were computed. Logistic regression models were used to examine the strength of associations between CSA and psychiatric disorders, adjusted for sociodemographic characteristics, risk factors, and other Axis I psychiatric disorders. Results: The prevalence of CSA was 10.14% (24.8% in men and 75.2% in women). Child physical abuse, maltreatment, and neglect were more prevalent among individuals with CSA than among those without it. Adults with CSA history had significantly higher rates of any Axis I disorder and suicide attempts. The frequency, type, and number of CSA were significantly correlated with psychopathology. Conclusions: The high correlation rates of CSA with psychopathology and increased risk for suicide attempts in adulthood suggest the need for a systematic assessment of psychiatric disorders and suicide risk in these individuals. The risk factors for CSA emphasize the need for health care initiatives geared toward increasing recognition and development of treatment approaches for the emotional sequelae CSA as well as early preventive approaches.
    Comprehensive psychiatry 07/2012; 54(1). DOI:10.1016/j.comppsych.2012.05.010 · 2.25 Impact Factor
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