Performance of a craving criterion in DSM alcohol use disorders.

OBJECTIVE: Adding a craving criterion--presently in the International Classification of Diseases, 10th Revision, diagnosis of alcohol dependence--has been under consideration as one possible improvement to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and was recently proposed for inclusion by the DSM Substance-Related Disorders Work Group in the Fifth Revision of diagnostic criteria for alcohol use disorders. To inform cross-cultural applicability of this modification, performance of a craving criterion was examined in emergency departments in four countries manifesting distinctly different culturally based drinking patterns (Mexico, Poland, Argentina, United States). METHOD: Exploratory factor analysis and item response theory were used to examine psychometric properties and individual item characteristics of the 11 DSM-IV abuse and dependence criteria with and without craving for each country separately. Differential item functioning analysis was performed to examine differences in the difficulty of endorsement (severity) and discrimination of craving across countries. RESULTS: Exploratory factor analysis found craving fit well within a one-dimensional solution, and factor loadings were high across all countries. Results from item-response theory analyses indicated that both discrimination and difficulty estimates for the craving item were located in the middle of the corresponding discrimination and difficulty ranges for the other 11 items for each country but did not substantially increase the efficiency (or information) of the overall diagnostic scheme. Across the four countries, no differential item functioning was found for difficulty, but significant differential item functioning was found for discrimination (similar to other DSM-IV criteria). CONCLUSIONS: Findings suggest that, although craving performed similarly across emergency departments in the four countries, it does not add much in identification of individuals with alcohol use disorders.

The prevalence and types of gambling among undocumented Mexican immigrants in New York City.

OBJECTIVES: To examine the prevalence of gambling and types of gambling activities in a sample of undocumented Mexican immigrants. DESIGN: Non-probability cross-sectional design. SETTING: New York City. SAMPLE: The 431 respondents ranged in age from 18 to 80 (mean age 32), 69.7% were male. RESULTS: More than half (53.8%) reported gambling in their lifetime and of those most (43.9%) played 'scratch and win' tickets or the lottery. In multivariate analyses men reported gambling more than women [2.13, 95% CI = (1.03, 4.38)]. The odds of gambling in their lifetime were higher among those reporting sending money to family or friends in the home country [2.65, 95% CI = 1.10, 6.38)], and those who reported 1-5 days as compared to no days of poor mental health in the past 30 days [2.44, 95% CI = 1.22, 4.89)]. Conversely, those who reported entering the U.S. to live after 1996 were less likely to report gambling [0.44, 95% CI = (0.22, 0.89)] as compared to those who had lived in the U.S. longer. CONCLUSION: There is a need to further explore both the prevalence and the severity of gambling amongst the growing population of undocumented Mexican immigrants in the U.S.