The Co-occurrence of DSM-IV Alcohol Abusein DSM-IV Alcohol Dependence: Results of the National Epidemiologic Survey on Alcohol and RelatedConditions on Heterogeneity That Differ by Population Subgroup

Division of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Archives of General Psychiatry (Impact Factor: 14.48). 10/2004; 61(9):891-6. DOI: 10.1001/archpsyc.61.9.891
Source: PubMed

ABSTRACT In DSM-IV, an alcohol abuse diagnosis is preempted by dependence, although the symptoms of each disorder are different. Consequently, little is known about the extent to which dependence occurs with or without abuse. The distinction is important because of potential heterogeneity in dependence as a phenotype in genetic research, as well as potential underestimation of alcohol dependence when surveys cover dependence symptoms only among those who screen positive for alcohol abuse.
To present the prevalence of DSM-IV alcohol dependence with and without alcohol abuse in national and population subgroups.
Face-to-face interviews.
The United States, including Alaska, Hawaii, and the District of Columbia.
Household and group-quarters residents, 18 years and older, in the National Epidemiologic Survey on Alcohol and Related Conditions (N = 42 392).
DSM-IV alcohol dependence with and without DSM-IV alcohol abuse, assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule.
Among respondents with current alcohol dependence, 33.7% did not additionally meet criteria for abuse (29.0% among men and 46.1% among women). Current dependence without abuse was especially common among minority women (48.5% among African Americans, 55.2% among Hispanics). Among respondents with lifetime diagnoses of dependence, 13.9% did not additionally meet criteria for abuse (10.1% among men, 22.1% among women): proportions were highest among minorities, eg, 29.1% among Hispanic women and 19.2% among Hispanic men.
Alcohol abuse does not always accompany alcohol dependence in the general population, especially among women and minorities. Dependence with and without abuse may represent heterogeneous phenotypes for genetic research. Use of alcohol abuse as a screening method for alcohol dependence in large epidemiologic studies will differentially underestimate the prevalence of dependence by subgroup, affecting time trend and comorbidity research. Such underestimation may also perpetuate a lack of services for traditionally underserved groups.

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    • "In diagnosing alcohol use disorder using the MINI questionnaire, dependence precludes a diagnosis of abuse. However, studies from the USA suggest the two diagnoses may co-occur: abuse patterns may occur in those with dependence; those with abuse may develop dependence [56,57]. ‘Acute alcohol’ intake may be associated with HIV risk, whereas dependence and long-term use may be associated with deleterious effects on health, increasing susceptibility to TB, and both patterns could impact on adherence. "
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    ABSTRACT: To determine the prevalence and correlates of alcohol dependence disorders in persons receiving treatment for HIV and Tuberculosis (TB) at 16 Primary Health Care centres (PHC) across Zambia. 649 adult patients receiving treatment for HIV and/or TB at PHCs in Zambia (363 males, 286 females) were recruited between 1st December 2009 and 31st January 2010. Data on socio-demographic variables, clinical disease features (TB and HIV), and psychopathological status were collected. The Mini International Neuropsychiatric Interview (MINI) was used to diagnose alcohol dependence disorder. Correlates of alcohol dependence were analyzed for men only, due to low prevalence in women. Univariable and multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI), using general estimating equations to allow for within-PHC clustering. The prevalence of alcohol dependence was 27.2% (95%CI: 17.7-39.5%) for men and 3.9% (95%CI: 1.4-0.1%) for women. Factors associated with alcohol dependence disorder in men included being single, divorced or widowed compared with married (adjusted OR = 1.47, 95%CI: 1.00-2.14) and being unemployed (adjusted OR=1.30, 95%CI: 1.01-1.67). The highest prevalence of alcohol dependence was among HIV-test unknown TB patients (34.7%), and lowest was among HIV positive patients on treatment but without TB (14.1%), although the difference was not statistically significant (p=0.38). Male TB/HIV patients in this population have high prevalence of alcohol dependence disorder, and prevalence differs by HIV/TB status. Further work is needed to explore interventions to reduce harmful drinking in this population.
    PLoS ONE 09/2013; 8(9):e74406. DOI:10.1371/journal.pone.0074406 · 3.23 Impact Factor
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    • "Blacks, Hispanics and adults ages 18e24 were oversampled, with data adjusted for oversampling, and for household-and person-level non-response. Interviews were conducted by experienced lay interviewers with extensive training and supervision (Hasin and Grant, 2004; Grant et al., 2008). All procedures, including informed consent, received full human subjects review and approval from the U.S. Census Bureau and U.S. Office of Management and Budget. "
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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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    • "Research evidence is inconclusive on the dimensionality of AUDs. A recent US population study (Hasin and Grant, 2004) found that of those who positively endorsed AD criteria, a third did not meet an AA diagnosis, suggesting that the AA criteria may measure a different latent construct. Plus assessment in a cross-national study showed that when data were manipulated on the basis of responses at either extremity, a two-factor model was found to be superior (Nelson et al., 1999). "
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    ABSTRACT: The dimensionality and the contribution of the proposed diagnostic criteria for the DSM-5 model of alcohol-use disorders (AUDs) which will provide guidelines for future diagnoses have not been examined in depth. Data from past year drinkers in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), Wave 2 (n=22 177) were analysed. Severity and discrimination of DSM-5 diagnostic criteria was determined using a two-parameter logistic Item Response Theory model. Comparative analyses were conducted on the DSM-IV criteria. Differential functioning of the criteria across a number of socio-demographic variables was assessed. The proposed criteria supported a unidimensional AUD model, with a factor loading range of 0.625-0.914 (craving=0.818). The model measured intermediate severity of AUDs with 'reduced time on important/pleasurable activities' and 'failure to meet major role obligations' criteria having the highest severity and discrimination. Craving, endorsed by 4.2% of the general population, was in the mid-range for both severity (sixth) and discrimination (seventh). Significant measurement bias was found on four criteria across socio-demographic subgroups. Application of the proposed DSM-5 changes yields an improved one-factor model of AUD over the existing DSM-IV model. Inclusion of a craving criterion improves the application of the diagnostic criteria in a general population sample, covering a previously unrepresented problem area. Additionally, criteria measuring the milder end of the AUD continuum remain absent and some criteria exhibit measurement non-invariance. The AUD classification may require further refinement to enhance validity and reliability.
    Drug and alcohol dependence 04/2012; 125(1-2):75-80. DOI:10.1016/j.drugalcdep.2012.03.019 · 3.42 Impact Factor
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