Article

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: 3.31). 03/2003; 27(2):244-52. DOI: 10.1097/01.ALC.0000060878.61384.ED
Source: PubMed

ABSTRACT 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.

0 Followers
 · 
81 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: There is a need to improve classification of alcohol use disorders (AUDs) in general population surveys. We developed and tested follow-up questions for 2 commonly reported symptom domains (withdrawal and larger/longer) to assess effects on Diagnostic and Statistical Manual-5 AUD classification. Telephone interviews recontacted a selective follow-up sample of respondents under age 46 from the 2010 National Alcohol Survey with at least 1 lifetime AUD symptom (n = 244). Items included detailed questions about past-year AUD symptoms. Three items (vomiting, sweating, irritability) were recoded as acute intoxication rather than withdrawal if they most recently occurred within 8 hours of stopping drinking. The larger/longer criterion was recoded as socially motivated if respondents endorsed "got caught up in drinking with a group of friends" and not "feel compelled to drink and just can't stop" as a reason for drinking more than intended. Of 225 current drinkers, 11% reported past-year withdrawal, with 28% of those reporting acute intoxication instead of physical withdrawal. Adjusting past-year withdrawal classification reduced AUD prevalence by 6%. A minority (12%) reported the past-year larger/longer criterion. Of those, 50% indicated social reasons for drinking more than intended, rather than compulsion to drink. Adjusting the past-year larger/longer criterion reduced AUD prevalence by 8%. Accounting for both adjustments reduced AUD prevalence by 13%. Cases that met AUD criteria after both adjustments were substantially heavier drinkers than those that were reclassified. Follow-up items could be implemented in epidemiologic studies with minimal response burden and may help reduce misclassification of AUD. Copyright © 2015 by the Research Society on Alcoholism.
    Alcoholism Clinical and Experimental Research 02/2015; 39(2). DOI:10.1111/acer.12627 · 3.31 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: People with severe mental illness (SMI) have often comorbid alcohol and other substance disorders but substantial barriers to addiction care remain.The study is aimed at describing correlates associated with dependence and with treatment for substance use among people with SMI and comorbid substance disorders cared in community mental health teams (CMHTs).Methods This study capitalized on data from a national survey on comorbid severe mental and substance use disorders, among 2,235 subjects in 42 CMHTs nationwide.Results26% of people with SMI and comorbid misuse suffered from dependence on alcohol and 21% on any other substance. Use of opioids, liver diseases, involvement with criminal justice system, but also area of residence, all were associated with dependence in people with SMI. As regards treatment for substance use, only 50% of comorbid people with SMI were treated by specialist services in the past 12 months. This was associated with opioids and cocaine use, as well as with liver diseases, and involvement with criminal justice. People with schizophrenia and those living in Central and Southern Italy, had the lowest chances to be treated for their comorbid substance use disorder.Conclusions There are extensive unmet treatment needs among comorbid individuals with SMI. Better integration of substance abuse and mental health care systems, and more effective reciprocal referral procedures, are needed.
    Comprehensive Psychiatry 11/2014; DOI:10.1016/j.comppsych.2014.11.021 · 2.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pathological gambling (PG) is now aligned with substance use disorders in the DSM-5 as the first officially recognized behavioral addiction. There is growing interest in examining obesity as an addictive disorder as well. The goal of this study was to investigate whether epidemiological data provide support for the consideration of PG and obesity as addictive disorders. Factor analysis of data from a large, nationally representative sample of US adults (N=43,093), using nicotine dependence, alcohol dependence, drug dependence, PG and obesity as indicators. It was hypothesized that nicotine dependence, alcohol dependence and drug use dependence would load on a single factor. It was further hypothesized that if PG and obesity were addictive disorders, they would load on the same factor as substance use disorders, whereas failure to load on the addictive factor would not support their conceptualization as addictive disorders. A model with one factor including nicotine dependence, alcohol dependence, drug dependence and PG, but not obesity, provided a very good fit to the data, as indicated by CFI=0.99, TLI=0.99 and RMSEA=0.01 and loadings of all indicators >0.4. Data from this study support the inclusion of PG in a latent factor with substance use disorders but do not lend support to the consideration of obesity, as defined by BMI, as an addictive disorder. Future research should investigate whether certain subtypes of obesity are best conceptualized as addictive disorders and the shared biological and environmental factors that account for the common and specific features of addictive disorders. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Preview

Download
3 Downloads
Available from