Abstract
Aims: To formulate harmful dysfunction (HD) diagnostic criteria for alcohol use disorder (AUD) and test whether they increase validity relative to standard DSM criteria, as evidenced by lowered prevalence, increased validator levels including service use, severity and family history and enhanced specificity. Design: DSM-IV AUD, DSM-IV dependence, DSM-5 AUD and HD AUD definitions were compared on eight validity related tests using nationally representative community data. Setting: United States. Participants: National Epidemiologic Survey of Alcoholism and Related Conditions (NESARC) respondents, aged 18-54years (wave 1, n=29673; wave 2, n=24244). Measures: NESARC DSM-IV and DSM-5 criteria were taken from published studies. Whereas DSM-5 diagnosis requires any two AUD symptoms, HD criteria were constructed from NESARC items to require symptoms of both impaired-control dysfunction [withdrawal, drink to prevent/stop withdrawal, cannot stop/reduce drinking, or craving (wave 2 only)] and harm (sacrificed important activities, problems caring for home/family, job/school problems, health problems, psychological problems or problems with family/friends). Validators included service use, severity and family history, among others. Specificity was tested using a teen transient drinker criterion group. Findings: Compared with DSM-5 AUD (DSM-IV results were similar), HD criteria yielded lower prevalence (95% confidence intervals): HD life-time 6.7% (6.2, 7.2%), 1-year 2.3% (2.0, 2.5%); and DSM-5 life-time 38.2% (36.5, 39.9%), 1-year 12.4% (11.7, 13.1%). HD AUD was higher than DSM-5 on pathology validators, including: life-time alcohol-related service use: HD 41.0% (38.1, 43.9%), DSM-5 11.5% (10.7, 12.3%); severity (number of life-time alcohol symptoms): HD 20.8 (20.4, 21.2), DSM-5 10.6 (10.4, 10.8); and family history of alcohol problems: HD 50.1% (47.3, 52.9), DSM-5 32.8% (31.6, 34.0). HD criteria eliminated 83% of a DSM-5 teen transient drinker false-positives criterion group. Conclusions: Prevalence estimates of alcohol use disorder are lowered and diagnostic validity improved when using 'harmful dysfunction' diagnostic criteria compared with standard DSM criteria, partly by reducing misdiagnosis of teenage transient drinkers.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 931-942 |
| Number of pages | 12 |
| Journal | Addiction |
| Volume | 110 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 1 2015 |
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Keywords
- Addiction
- Alcohol dependence
- Alcohol use disorder
- Concept of mental disorder
- Diagnosis
- Diagnostic criteria
- DSM
- DSM-5
- DSM-IV
- Harmful dysfunction
- NESARC
- Psychiatric epidemiology
- Validity
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Psychiatry and Mental health
Cite this
The harmful dysfunction model of alcohol use disorder : Revised criteria to improve the validity of diagnosis and prevalence estimates. / Wakefield, Jerome C.; Schmitz, Mark F.
In: Addiction, Vol. 110, No. 6, 01.06.2015, p. 931-942.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The harmful dysfunction model of alcohol use disorder
T2 - Revised criteria to improve the validity of diagnosis and prevalence estimates
AU - Wakefield, Jerome C.
AU - Schmitz, Mark F.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Aims: To formulate harmful dysfunction (HD) diagnostic criteria for alcohol use disorder (AUD) and test whether they increase validity relative to standard DSM criteria, as evidenced by lowered prevalence, increased validator levels including service use, severity and family history and enhanced specificity. Design: DSM-IV AUD, DSM-IV dependence, DSM-5 AUD and HD AUD definitions were compared on eight validity related tests using nationally representative community data. Setting: United States. Participants: National Epidemiologic Survey of Alcoholism and Related Conditions (NESARC) respondents, aged 18-54years (wave 1, n=29673; wave 2, n=24244). Measures: NESARC DSM-IV and DSM-5 criteria were taken from published studies. Whereas DSM-5 diagnosis requires any two AUD symptoms, HD criteria were constructed from NESARC items to require symptoms of both impaired-control dysfunction [withdrawal, drink to prevent/stop withdrawal, cannot stop/reduce drinking, or craving (wave 2 only)] and harm (sacrificed important activities, problems caring for home/family, job/school problems, health problems, psychological problems or problems with family/friends). Validators included service use, severity and family history, among others. Specificity was tested using a teen transient drinker criterion group. Findings: Compared with DSM-5 AUD (DSM-IV results were similar), HD criteria yielded lower prevalence (95% confidence intervals): HD life-time 6.7% (6.2, 7.2%), 1-year 2.3% (2.0, 2.5%); and DSM-5 life-time 38.2% (36.5, 39.9%), 1-year 12.4% (11.7, 13.1%). HD AUD was higher than DSM-5 on pathology validators, including: life-time alcohol-related service use: HD 41.0% (38.1, 43.9%), DSM-5 11.5% (10.7, 12.3%); severity (number of life-time alcohol symptoms): HD 20.8 (20.4, 21.2), DSM-5 10.6 (10.4, 10.8); and family history of alcohol problems: HD 50.1% (47.3, 52.9), DSM-5 32.8% (31.6, 34.0). HD criteria eliminated 83% of a DSM-5 teen transient drinker false-positives criterion group. Conclusions: Prevalence estimates of alcohol use disorder are lowered and diagnostic validity improved when using 'harmful dysfunction' diagnostic criteria compared with standard DSM criteria, partly by reducing misdiagnosis of teenage transient drinkers.
AB - Aims: To formulate harmful dysfunction (HD) diagnostic criteria for alcohol use disorder (AUD) and test whether they increase validity relative to standard DSM criteria, as evidenced by lowered prevalence, increased validator levels including service use, severity and family history and enhanced specificity. Design: DSM-IV AUD, DSM-IV dependence, DSM-5 AUD and HD AUD definitions were compared on eight validity related tests using nationally representative community data. Setting: United States. Participants: National Epidemiologic Survey of Alcoholism and Related Conditions (NESARC) respondents, aged 18-54years (wave 1, n=29673; wave 2, n=24244). Measures: NESARC DSM-IV and DSM-5 criteria were taken from published studies. Whereas DSM-5 diagnosis requires any two AUD symptoms, HD criteria were constructed from NESARC items to require symptoms of both impaired-control dysfunction [withdrawal, drink to prevent/stop withdrawal, cannot stop/reduce drinking, or craving (wave 2 only)] and harm (sacrificed important activities, problems caring for home/family, job/school problems, health problems, psychological problems or problems with family/friends). Validators included service use, severity and family history, among others. Specificity was tested using a teen transient drinker criterion group. Findings: Compared with DSM-5 AUD (DSM-IV results were similar), HD criteria yielded lower prevalence (95% confidence intervals): HD life-time 6.7% (6.2, 7.2%), 1-year 2.3% (2.0, 2.5%); and DSM-5 life-time 38.2% (36.5, 39.9%), 1-year 12.4% (11.7, 13.1%). HD AUD was higher than DSM-5 on pathology validators, including: life-time alcohol-related service use: HD 41.0% (38.1, 43.9%), DSM-5 11.5% (10.7, 12.3%); severity (number of life-time alcohol symptoms): HD 20.8 (20.4, 21.2), DSM-5 10.6 (10.4, 10.8); and family history of alcohol problems: HD 50.1% (47.3, 52.9), DSM-5 32.8% (31.6, 34.0). HD criteria eliminated 83% of a DSM-5 teen transient drinker false-positives criterion group. Conclusions: Prevalence estimates of alcohol use disorder are lowered and diagnostic validity improved when using 'harmful dysfunction' diagnostic criteria compared with standard DSM criteria, partly by reducing misdiagnosis of teenage transient drinkers.
KW - Addiction
KW - Alcohol dependence
KW - Alcohol use disorder
KW - Concept of mental disorder
KW - Diagnosis
KW - Diagnostic criteria
KW - DSM
KW - DSM-5
KW - DSM-IV
KW - Harmful dysfunction
KW - NESARC
KW - Psychiatric epidemiology
KW - Validity
UR - http://www.scopus.com/inward/record.url?scp=84929132305&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84929132305&partnerID=8YFLogxK
U2 - 10.1111/add.12859
DO - 10.1111/add.12859
M3 - Article
C2 - 25622535
AN - SCOPUS:84929132305
VL - 110
SP - 931
EP - 942
JO - Addiction
JF - Addiction
SN - 0965-2140
IS - 6
ER -