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The harmful dysfunction model of alcohol use disorder: revised criteria to improve the validity of diagnosis and prevalence estimates.
Addiction 2015; 110(6):931-42A

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 18-54 years (wave 1, n = 29 673; wave 2, n = 24 244).

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.

Authors+Show Affiliations

School of Social Work and Department of Psychiatry, New York University, New York, NY,, USA.School of Social Work, Temple University, Philadelphia, PA,, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25622535

Citation

Wakefield, Jerome C., and Mark F. Schmitz. "The Harmful Dysfunction Model of Alcohol Use Disorder: Revised Criteria to Improve the Validity of Diagnosis and Prevalence Estimates." Addiction (Abingdon, England), vol. 110, no. 6, 2015, pp. 931-42.
Wakefield JC, Schmitz MF. The harmful dysfunction model of alcohol use disorder: revised criteria to improve the validity of diagnosis and prevalence estimates. Addiction. 2015;110(6):931-42.
Wakefield, J. C., & Schmitz, M. F. (2015). The harmful dysfunction model of alcohol use disorder: revised criteria to improve the validity of diagnosis and prevalence estimates. Addiction (Abingdon, England), 110(6), pp. 931-42. doi:10.1111/add.12859.
Wakefield JC, Schmitz MF. The Harmful Dysfunction Model of Alcohol Use Disorder: Revised Criteria to Improve the Validity of Diagnosis and Prevalence Estimates. Addiction. 2015;110(6):931-42. PubMed PMID: 25622535.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The harmful dysfunction model of alcohol use disorder: revised criteria to improve the validity of diagnosis and prevalence estimates. AU - Wakefield,Jerome C, AU - Schmitz,Mark F, Y1 - 2015/02/24/ PY - 2014/07/29/received PY - 2014/10/31/revised PY - 2015/01/14/accepted PY - 2015/1/28/entrez PY - 2015/1/28/pubmed PY - 2017/1/11/medline KW - Addiction KW - DSM KW - DSM-5 KW - DSM-IV KW - NESARC KW - alcohol dependence KW - alcohol use disorder KW - concept of mental disorder KW - diagnosis KW - diagnostic criteria KW - harmful dysfunction KW - psychiatric epidemiology KW - validity SP - 931 EP - 42 JF - Addiction (Abingdon, England) JO - Addiction VL - 110 IS - 6 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 18-54 years (wave 1, n = 29 673; wave 2, n = 24 244). 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. SN - 1360-0443 UR - https://www.unboundmedicine.com/medline/citation/25622535/The_harmful_dysfunction_model_of_alcohol_use_disorder:_revised_criteria_to_improve_the_validity_of_diagnosis_and_prevalence_estimates_ L2 - https://doi.org/10.1111/add.12859 DB - PRIME DP - Unbound Medicine ER -