Christopher S Martin1, Alvaro Vergés2, James W Langenbucher3, Andrew Littlefield4, Tammy Chung1, Duncan B Clark1, Kenneth J Sher5. 1. Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 2. Escuela de Psicología, Pontifica Universidad Católica de Chile, Santiago, Chile. 3. Center of Alcohol Studies, Rutgers University, New Brunswick, New Jersey. 4. Department of Psychological Sciences, Texas Tech University, Lubbock, Texas. 5. Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri.
Abstract
BACKGROUND: Alcohol withdrawal (AW) is an important clinical and diagnostic feature of alcohol dependence. AW has been found to predict a worsened course of illness in clinical samples, but in some community studies, AW endorsement rates are strikingly high, suggesting false-positive symptom assignments. Little research has examined the validity of the DSM-5 algorithm for AW, which requires either the presence of at least 2 of 8 subcriteria (i.e., autonomic hyperactivity, tremulousness, insomnia, nausea, hallucinations, psychomotor agitation, anxiety, and grand mal seizures), or, the use of alcohol to avoid or relieve these symptoms. METHODS: We used item and algorithm analyses of data from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (current drinkers, n = 26,946 at wave 1) to study the validity of DSM-5 AW as operationalized by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV (AUDADIS-IV). RESULTS: A substantial proportion of individuals given the AW symptom reported only modest to moderate levels of alcohol use and alcohol problems. Alternative AW algorithms were superior to DSM-5 in terms of levels of alcohol use and alcohol problem severity among those with AW, group difference effect sizes, and predictive validity at a 3-year follow-up. The superior alternative algorithms included those that excluded the nausea subcriterion; required withdrawal-related distress or impairment; increased the AW subcriteria threshold from 2 to 3 items; and required tremulousness for AW symptom assignment. CONCLUSIONS: The results indicate that the DSM-5 definition of AW, as assessed by the AUDADIS-IV, has low specificity. This shortcoming can be addressed by making the algorithm for symptom assignment more stringent.
BACKGROUND:Alcohol withdrawal (AW) is an important clinical and diagnostic feature of alcohol dependence. AW has been found to predict a worsened course of illness in clinical samples, but in some community studies, AW endorsement rates are strikingly high, suggesting false-positive symptom assignments. Little research has examined the validity of the DSM-5 algorithm for AW, which requires either the presence of at least 2 of 8 subcriteria (i.e., autonomic hyperactivity, tremulousness, insomnia, nausea, hallucinations, psychomotor agitation, anxiety, and grand mal seizures), or, the use of alcohol to avoid or relieve these symptoms. METHODS: We used item and algorithm analyses of data from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (current drinkers, n = 26,946 at wave 1) to study the validity of DSM-5 AW as operationalized by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV (AUDADIS-IV). RESULTS: A substantial proportion of individuals given the AW symptom reported only modest to moderate levels of alcohol use and alcohol problems. Alternative AW algorithms were superior to DSM-5 in terms of levels of alcohol use and alcohol problem severity among those with AW, group difference effect sizes, and predictive validity at a 3-year follow-up. The superior alternative algorithms included those that excluded the nausea subcriterion; required withdrawal-related distress or impairment; increased the AW subcriteria threshold from 2 to 3 items; and required tremulousness for AW symptom assignment. CONCLUSIONS: The results indicate that the DSM-5 definition of AW, as assessed by the AUDADIS-IV, has low specificity. This shortcoming can be addressed by making the algorithm for symptom assignment more stringent.
Authors: K K Bucholz; R Cadoret; C R Cloninger; S H Dinwiddie; V M Hesselbrock; J I Nurnberger; T Reich; I Schmidt; M A Schuckit Journal: J Stud Alcohol Date: 1994-03
Authors: M A Schuckit; T L Smith; J B Daeppen; M Eng; T K Li; V M Hesselbrock; J I Nurnberger; K K Bucholz Journal: Am J Psychiatry Date: 1998-06 Impact factor: 18.112
Authors: Ofir Livne; Richard Feinn; Justin Knox; Emily E Hartwell; Joel Gelernter; Deborah S Hasin; Henry R Kranzler Journal: Alcohol Clin Exp Res Date: 2022-03 Impact factor: 3.455
Authors: Alvaro Vergés; Matthew R Lee; Christopher S Martin; Timothy J Trull; Matthew P Martens; Phillip K Wood; Kenneth J Sher Journal: Psychol Addict Behav Date: 2021-05-06
Authors: Juhaina Salim Al-Maqbali; Nasiba Al-Maqrashi; Aisha Al-Huraizi; Qasim Sultan Al-Mamari; Khalifa Al Alawa; Abdullah M Al Alawi Journal: Ann Saudi Med Date: 2022-02-03 Impact factor: 1.526