Toward DSM-V: mapping the alcohol use disorder continuum in college students.

OBJECTIVE: The present study examined the dimensionality of DSM-IV Alcohol Use Disorder (AUD) criteria using Item Response Theory (IRT) methods and tested the validity of the proposed DSM-V AUD guidelines in a sample of college students.
METHOD: Participants were 396 college students who reported any alcohol use in the past 90 days and were aged 18 years or older. We conducted factor analyses to determine whether a one- or two-factor model provided a better fit to the AUD criteria. IRT analyses estimated item severity and discrimination parameters for each criterion. Multivariate analyses examined differences among the DSM-V diagnostic cut-off (AUD vs. No AUD) and severity qualifiers (no diagnosis, moderate, severe) across several validating measures of alcohol use.
RESULTS: A dominant single-factor model provided the best fit to the AUD criteria. IRT analyses indicated that abuse and dependence criteria were intermixed along the latent continuum. The "legal problems" criterion had the highest severity parameter and the tolerance criterion had the lowest severity parameter. The abuse criterion "social/interpersonal problems" and dependence criterion "activities to obtain alcohol" had the highest discrimination parameter estimates. Multivariate analysis indicated that the DSM-V cut-off point, and severity qualifier groups were distinguishable on several measures of alcohol consumption, drinking consequences, and drinking restraint. DISCUSSION: Findings suggest that the AUD criteria reflect a latent variable that represents a primary disorder and provide support for the proposed DSM-V AUD criteria in a sample of college students. Continued research in other high-risk samples of college students is needed.