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Dimensionality and stages of severity of DSM-5 criteria in an international sample of alcohol-consuming individuals

Published online by Cambridge University Press:  25 April 2014

U. W. Preuss ,
S. Watzke  and
F. M. Wurst
U. W. Preuss*
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, University of Halle-Wittenberg, Germany
S. Watzke
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, University of Halle-Wittenberg, Germany
F. M. Wurst
Affiliation:
Department of Psychiatry and Psychotherapy II, Paracelsus University, Salzburg, Austria
*
*Address for correspondence: U. W. Preuss, Professor of Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Martin-Luther-University of Halle-Wittenberg, Julius-Kühn-Straße 7, 06097 Halle/Saale, Germany. (Email: ulrich.preuss@medizin.uni-halle.de)
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Abstract

Introduction.

The DSM-5 alcohol use disorder (AUD) criteria proposal contains 11 criteria that include most of the DSM-IV abuse and dependence criteria plus craving. The aims of the current study in a large and international alcohol-consuming sample were to confirm the dimensionality of the DSM-5 AUD criteria and to differentiate grades of severity of DSM-5 AUD in subjects who pass the proposed DSM-5 diagnostic threshold of two criteria.

Method.

We used the World Health Organization (WHO)/International Society on Biomedical Research on Alcoholism (ISBRA) Study on State and Trait Markers of Alcohol Use and Dependence dataset. Subjects included in the analyses were aged ⩾18 years and were recruited in five countries: Australia, Brazil, Canada, Finland and Japan. Assessment of AUD and additional characteristics was conducted using an adapted version of the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS). Dimensionality of the DSM-5 criteria was evaluated using factor analysis and item response theory (IRT) models. The IRT results led to the classification of AUD patients into three severity groups. External validators were used to differentiate statistically across subgroups.

Results.

A total of 1424 currently drinking individuals were included in the analyses. Factor and IRT analyses confirmed the dimensional structure of DSM-5 AUD criteria. More than 99% of the subjects could be allocated to one of the suggested severity subgroups. The magnitude of the external validators differed significantly across the severity groups.

Conclusions.

The results confirm the dimensional structure of the proposed DSM-5 AUD criteria. The suggested stages of severity (mild, moderate and severe) may be useful to clinicians by grouping individuals not only in the mild but also in the moderate to severe spectrum of DSM-5 AUD.

Keywords

Alcohol use disorder severityalcohol use disordersDSM-5item response theory
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 15 , November 2014 , pp. 3303 - 3314
Copyright
Copyright © Cambridge University Press 2014 

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