Zachary L Mannes1,2, Dvora Shmulewitz2,3, Ofir Livne1,2, Malki Stohl2,3, Deborah S Hasin1,2,3. 1. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA. 2. New York State Psychiatric Institute, New York, New York, USA. 3. Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.
Abstract
BACKGROUND: The DSM-5 definition of alcohol use disorder (AUD) has been well validated, but information is lacking on the extent to which alcohol use, comorbidity, and impairment are associated with the 3 DSM-5-defined AUD severity levels: mild, moderate, and severe. This study examined clinical and functional characteristics as predictors (validators) of these severity levels. METHODS: Participants aged ≥18 years reporting current problem substance use (N = 588) were recruited between 2016 and 2019 and assessed for DSM-5 AUD and a set of potential validators: indicators of alcohol use severity (i.e., craving, binge drinking frequency, problematic use, and harmful drinking), psychiatric disorders, and functional impairment. Multinomial logistic regression models examined the association between the predictors and the 3 AUD severity levels (mild, moderate, and severe) vs the reference group, no AUD, controlling for sociodemographic characteristics and other substance use. RESULTS: All alcohol use validators were associated with a greater likelihood of all 3 AUD severity levels compared with the no-AUD group. However, psychiatric disorders were associated only with severe AUD and participants with major depression (aOR = 2.44), posttraumatic stress disorder (aOR = 1.65), borderline personality disorder (aOR = 1.99), and antisocial personality disorder (aOR = 1.78) had a greater likelihood of severe AUD than the no-AUD group. Functioning validators were also associated only with severe AUD and participants with social (aOR = 1.87), physical (aOR = 1.62), or mental (aOR = 1.84) impairment had a greater likelihood of severe AUD than the no-AUD group. Many alcohol-related, psychiatric, and functioning validators were associated with greater odds of severe AUD than mild or moderate AUD. CONCLUSION: This study supports the criterion validity of the DSM-5 tri-categorical measure of AUD. Specifically, results fully supported the validity of severe AUD by its associations with all predictors, whereas the validity of mild and moderate AUD was supported only by alcohol use predictor variables. Findings suggest the value of using severity-specific interventions utilizing the DSM-5 AUD.
BACKGROUND: The DSM-5 definition of alcohol use disorder (AUD) has been well validated, but information is lacking on the extent to which alcohol use, comorbidity, and impairment are associated with the 3 DSM-5-defined AUD severity levels: mild, moderate, and severe. This study examined clinical and functional characteristics as predictors (validators) of these severity levels. METHODS: Participants aged ≥18 years reporting current problem substance use (N = 588) were recruited between 2016 and 2019 and assessed for DSM-5 AUD and a set of potential validators: indicators of alcohol use severity (i.e., craving, binge drinking frequency, problematic use, and harmful drinking), psychiatric disorders, and functional impairment. Multinomial logistic regression models examined the association between the predictors and the 3 AUD severity levels (mild, moderate, and severe) vs the reference group, no AUD, controlling for sociodemographic characteristics and other substance use. RESULTS: All alcohol use validators were associated with a greater likelihood of all 3 AUD severity levels compared with the no-AUD group. However, psychiatric disorders were associated only with severe AUD and participants with major depression (aOR = 2.44), posttraumatic stress disorder (aOR = 1.65), borderline personality disorder (aOR = 1.99), and antisocial personality disorder (aOR = 1.78) had a greater likelihood of severe AUD than the no-AUD group. Functioning validators were also associated only with severe AUD and participants with social (aOR = 1.87), physical (aOR = 1.62), or mental (aOR = 1.84) impairment had a greater likelihood of severe AUD than the no-AUD group. Many alcohol-related, psychiatric, and functioning validators were associated with greater odds of severe AUD than mild or moderate AUD. CONCLUSION: This study supports the criterion validity of the DSM-5 tri-categorical measure of AUD. Specifically, results fully supported the validity of severe AUD by its associations with all predictors, whereas the validity of mild and moderate AUD was supported only by alcohol use predictor variables. Findings suggest the value of using severity-specific interventions utilizing the DSM-5 AUD.
Authors: Deborah S Hasin; Melanie Wall; Katie Witkiewitz; Henry R Kranzler; Daniel Falk; Raye Litten; Karl Mann; Stephanie S O'Malley; Jennifer Scodes; Rebecca L Robinson; Raymond Anton Journal: Lancet Psychiatry Date: 2017-04-26 Impact factor: 27.083
Authors: Deborah S Hasin; Eliana Greenstein; Christina Aivadyan; Malki Stohl; Efrat Aharonovich; Tulshi Saha; Rise Goldstein; Edward V Nunes; Jeesun Jung; Haitao Zhang; Bridget F Grant Journal: Drug Alcohol Depend Date: 2014-12-18 Impact factor: 4.492
Authors: Jürgen Rehm; Gerhard E Gmel; Gerrit Gmel; Omer S M Hasan; Sameer Imtiaz; Svetlana Popova; Charlotte Probst; Michael Roerecke; Robin Room; Andriy V Samokhvalov; Kevin D Shield; Paul A Shuper Journal: Addiction Date: 2017-02-20 Impact factor: 6.526