Dimensionality of lifetime alcohol abuse, dependence and binge drinking.

Questions relevant to DSM-V alcohol use disorders (AUD) include whether dimensional measures provide more information than categorical diagnoses, whether to combine abuse and dependence criteria, and whether to add a new diagnostic criterion, binge drinking. Binary and dimensional models of three versions of AUD criteria were investigated: (1) dependence criteria; (2) abuse and dependence criteria combined; and (3) abuse and dependence criteria combined with a binge drinking criterion added. In a national sample of lifetime drinkers (N=27,324), these models of AUD criteria were investigated in relation to two well-established risk factors for AUD, family history and early drinking onset. Logistic or Poisson regression modeled the relationships between the validating variables and dependence in categorical, dimensional and hybrid forms; Wald tests were used to assess differences between the dimensional, categorical and hybrid models. Alcohol dependence criteria represented a single continuum (family history Wald=9.93, p=0.13; early drinking Wald=7.62, p=0.27) with no support for a categorical or hybrid version of alcohol dependence. Adding four abuse criteria produced similar results for family history (Wald=15.4, p=0.12) although with early drinking, this model showed a trend towards deviating from the data (Wald=16.7, p=0.08). No support was found for any diagnostic threshold at 3, 4, 5, 6, or 7 criteria when abuse and dependence were combined. Adding binge drinking resulted in a significant departure from linearity for family history (Wald=21.8, p=0.03) and early drinking (Wald=23.9, p=0.01). The number of alcohol dependence and abuse criteria met should be explored further as a useful AUD severity indicator or phenotype.