Evolution of Dementia Related to the Use of Alcohol in the French Nationwide Discharge Summary Database Between 2007 and 2017.

BACKGROUND: The French nationwide exhaustive hospital discharge database (PMSI) is used for activity-based payment of hospital services. We hypothesized that the release of articles about alcohol and dementia could influence the identification of these diagnoses in PMSI. METHODS: We analyzed temporal evolution of coding for dementia and other persistent or late-onset cognitive impairment (OPLOCI) due to alcohol and other psychoactive substances in the PMSI database from 2007 to 2017 (285 748 938 inpatient stays). These codings use the International Classification of Diseases, 10th revision (ICD-10). RESULTS: The number of inpatient stays with dementia and OPLOCI due to alcohol increased from 34 to 1704 from 2007 to 2017. While the number of diagnosed dementias remained stable at around 400 from 2013, the number of OPLOCIs increased 10-fold from 2013 to 2017. This increase was not found with dementia or OPLOCI due to other psychoactive substances than alcohol. CONCLUSION: Notoriety of a diagnosis in the literature seems to have an impact on the coding.

Drunkorexia: A new term and diagnostic criteria.

Individuals who restrict their caloric intake and/or exercise excessively to mitigate the calories from alcohol consumption may suffer from an eating disorder, substance abuse disorder, or both. While the term "drunkorexia" has been used in both academic articles and popular culture, issues persist with respect to diagnosing and treating this condition. Classifying the behavior as a subcategory of Other Specified Feeding and Eating Disorders (OSFED) would provide patients with an increased likelihood of receiving insurance coverage for this condition. A consistent definition of this behavior and a more medically accurate/appropriate term-such as "alcoholimia"-are both needed to advance treatment and prevention efforts.

Level of agreement between medical record and ICD-10-AM coding of mental health, alcohol and drug conditions in trauma patients.

BACKGROUND: Despite the reliance on administrative data in epidemiological studies, there is little information on the completeness of co-morbidities in administrative data coded from medical records. OBJECTIVE: The aim of this study was to quantify the agreement between the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) administrative coding of mental health, drug and alcohol co-morbidities and medical records in a severely injured patient population. METHOD: A random sample of patients (n = 500) captured by the Victorian State Trauma Registry and definitively managed at the state's adult major trauma services was selected for the study. Retrospective medical record review was conducted to collect data about documented co-morbidities. The agreement between ICD-10-AM data generated from routine hospital coding and medical record-based co-morbidities was determined using Cohen's κ and prevalence-adjusted bias-adjusted kappa (PABAK) statistics. RESULTS: The percentage of agreement between the medical record and ICD-10-AM coding for mental health, drug and alcohol co-morbidities was 72.8%, and the PABAK showed moderate agreement (PABAK = 0.46; 95% confidence interval (CI): 0.37, 0.54). There was no difference in agreement between unintentional injury patients (PABAK = 0.52; 95% CI: 0.42, 0.62) compared with intentional injury patients (PABAK = 0.36, 95% CI: 0.23, 0.49), and no change in agreement for patients admitted before (PABAK = 0.40; 95% CI: 0.30, 0.50) and after the introduction of mandatory co-morbidity coding (PABAK = 0.46; 95% CI: 0.37, 0.54). CONCLUSION: Despite documentation in the medical record, a large proportion of mental health, drug and alcohol conditions were not coded in ICD-10-AM. Acknowledgement of these limitations is needed when using ICD-10-AM coded co-morbidities in research studies and health policy development. IMPLICATIONS: This work has implications for researchers of drug and alcohol abuse; mental health; accidents and injuries; workers' compensation; health workforce; health services; and policy decisions for healthcare, emergency services, insurance industry, national productivity and welfare costings reliant on those research outcomes.

Patterns of Alcohol Use in Italian Emerging Adults: A Latent Class Analysis Study.

AIMS: The goals of the current study were to identify latent classes of alcohol users among Italian emerging adults (18-33 years), examine differences in the class solution based on socio-demographic characteristics, and examine whether differences exist across classes in experiencing different types of alcohol-related negative consequences. METHODS: Participants (N = 5955; 62.72% female; mean age 27.19 years) were drawn from a pre-recruited Web panel designed to be representative of the Italian young adults (18-33 years) population. Latent class analysis (LCA) was used to identify common patterns of alcohol use. RESULTS: Four classes of drinking patterns were identified: (a) Current Nondrinkers (15%); (b) Weekend Non-Risky Drinkers (51%); (c) Weekend Risky Drinkers (20%); and (d) Daily Drinkers (13%). The number and type of classes did not differ across several demographic variables, although proportions within classes varied by sex, age, occupation status and geographic area. Weekend Risky Drinkers experienced the greatest number of alcohol-related negative consequences. CONCLUSIONS: The great majority of the sample displayed drinking patterns with relatively infrequent involvement in risky drinking. Preventive interventions should, instead, target those who drink alcohol on weekends only, but show the greatest negative consequences. SHORT SUMMARY: Four classes of drinking patterns were identified in a large representative sample of Italian young adults. The great majority of the sample displayed drinking patterns with relatively little involvement in risky drinking, though those misusing alcohol at weekends were at greatest risk to experience alcohol-related negative consequences.

The CERAD Neuropsychological Assessment Battery Is Sensitive to Alcohol-Related Cognitive Deficiencies in Elderly Patients: A Retrospective Matched Case-Control Study.

OBJECTIVES: Adverse effects of heavy drinking on cognition have frequently been reported. In the present study, we systematically examined for the first time whether clinical neuropsychological assessments may be sensitive to alcohol abuse in elderly patients with suspected minor neurocognitive disorder. METHODS: A total of 144 elderly with and without alcohol abuse (each group n=72; mean age 66.7 years) were selected from a patient pool of n=738 by applying propensity score matching (a statistical method allowing to match participants in experimental and control group by balancing various covariates to reduce selection bias). Accordingly, study groups were almost perfectly matched regarding age, education, gender, and Mini Mental State Examination score. Neuropsychological performance was measured using the CERAD (Consortium to Establish a Registry for Alzheimer's Disease). Classification analyses (i.e., decision tree and boosted trees models) were conducted to examine whether CERAD variables or total score contributed to group classification. RESULTS: Decision tree models disclosed that groups could be reliably classified based on the CERAD variables "Word List Discriminability" (tapping verbal recognition memory, 64% classification accuracy) and "Trail Making Test A" (measuring visuo-motor speed, 59% classification accuracy). Boosted tree analyses further indicated the sensitivity of "Word List Recall" (measuring free verbal recall) for discriminating elderly with versus without a history of alcohol abuse. CONCLUSIONS: This indicates that specific CERAD variables seem to be sensitive to alcohol-related cognitive dysfunctions in elderly patients with suspected minor neurocognitive disorder. (JINS, 2018, 24, 360-371).

Neurocognitive dysfunction in addiction: Testing hypotheses of diffuse versus selective phenotypic dysfunction with a classification-based approach.

Neurocognitive dysfunctions are frequently identified in the addictions. These dysfunctions may indicate either diffuse dysfunction or may represent separate facets that have differential importance to the addiction phenotype. In a sample (n = 260) of alcohol and/or stimulant users and controls we measured responses across 7 diverse neurocognitive measures. These measures were Continuous Performance, Delay Discounting, Iowa Gambling, Stroop, Tower, Wisconsin Card Sorting, and Letter Number Sequencing. Comparisons were then made between the drug-dependent groups and controls using analysis of variance and also using a machine learning approach to classify participants based on task performance as substance-dependent or controls in 1 tree and as alcohol and/or stimulant users or controls in a second tree. The analysis of variance showed significant differences between groups on the Delay Discounting (p < .001), Iowa Gambling (p < .001), Letter Number Sequencing (p < .001), and Wisconsin Card Sorting (p < .05) tasks. The first classification tree correctly classified between substance-dependent or controls for 88.3% of participants and classified between alcohol and/or stimulant users or controls for 63.9% of participants. Delay discounting was the first split in both trees and in the substance-dependent and control tree. The analysis of variance results largely replicate previous findings. The machine learning classification tree analysis provides evidence to support the hypothesis that different measures of neurocognitive dysfunction represent different processes. Among them, delay discounting was the most robust in categorizing drug dependence. (PsycINFO Database Record

Contemporary alcohol use patterns among a national sample of U.S. adult drinkers.

The aim of the current article is to identify subgroups of adult drinkers characterized by typical drinking patterns. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III were used to classify drinkers based on several indicators of drinking. Past-year drinkers aged 18-64 were included (n = 22,776). Latent class analysis revealed a 5-class model: Occasional, Light Drinkers (28%), Frequent Drinkers (25%), Infrequent Drinkers with Occasional Binging (5%), Frequent Drinkers with Occasional Binging (22%), and High-Intensity Drinkers (20%). Although most were Light Drinkers, many engaged in excessive drinking. Given the potential risk for harm, prevention efforts are warranted particularly for High-Intensity Drinkers.

The search for an elusive cutoff remains: Problems of binary classification of heavy drinking as an endpoint for alcohol clinical trials.

BACKGROUND: To examine whether a clinically meaningful alcohol consumption cutoff can be created for clinical samples, we used receiver operator characteristic (ROC) curves to derive gender-specific consumption cutoffs that maximized sensitivity and specificity in the prediction of a wide range of negative consequences from drinking. METHODS: We conducted secondary data analyses using data from two large clinical trials targeting alcohol use disorders: Project MATCH (n=1726) and COMBINE (n=1383). RESULTS: In both studies, we found that the ideal cutoff for men and women that maximized sensitivity/specificity varied substantially both across different alcohol consumption variables and alcohol consequence outcomes. Further, the levels of sensitivity/specificity were poor across all consequences. CONCLUSIONS: These results fail to provide support for a clinically meaningful alcohol consumption cutoff and suggest that binary classification of levels of alcohol consumption is a poor proxy for maximizing sensitivity/specificity in the prediction of negative consequences from drinking. Future research examining consumption-consequence associations should take advantage of continuous measures of alcohol consumption and alternative approaches for assessing the link between levels of consumption and consequences (e.g., ecological momentary assessment). Clinical researchers should consider focusing more directly on the consequences they aim to reduce instead of relying on consumption as a proxy for more clinically meaningful outcomes.

Rates of past-year alcohol treatment across two time metrics and differences by alcohol use disorder severity and mental health comorbidities.

INTRODUCTION: Little is known about how alcohol treatment rates vary across age or years since onset of an alcohol use disorder (AUD). We examined past-year treatment prevalence and associations across these important time metrics. METHOD: Data on 22,278 adults ages 18-50 were from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013). We examined the age-varying prevalence of alcohol treatment and associations of past-year AUD severity, MDD status, and DUD status with treatment. Additionally, for individuals with a lifetime AUD (N=7089), we examined associations of severity, MDD, and DUD across years since AUD onset. RESULTS: Individuals with Moderate/Severe past-year AUD had significantly higher treatment rates at nearly all ages, compared to those with Mild or no AUD. For those with Moderate/Severe AUD, treatment rates were highest during late adolescence and middle adulthood and lowest during early adulthood. Mental health comorbidities were positively associated with treatment at certain age ranges in mid-adulthood. Among individuals with a lifetime AUD, those with Moderate/Severe past-year AUD had significantly higher past-year treatment rates across all years since onset. MDD and DUD were both positively associated with treatment at nearly all years since AUD onset. CONCLUSIONS: Alcohol treatment rates varied notably by age and, to a lesser extent, by years since AUD onset. Greater AUD severity was consistently associated with higher rates of treatment, whereas Mild AUD had a much weaker relationship. MDD and DUD showed similar patterns of positive association with treatment. Our results highlight important subgroups where unmet treatment needs are highest.

A Cross-National Examination of Differences in Classification of Lifetime Alcohol Use Disorder Between DSM-IV and DSM-5: Findings from the World Mental Health Survey.

BACKGROUND: The current study sought to examine the diagnostic overlap in DSM-IV and DSM-5 alcohol use disorder (AUD) and determine the clinical correlates of changing diagnostic status across the 2 classification systems. METHODS: DSM-IV and DSM-5 definitions of AUD were compared using cross-national community survey data in 9 low-, middle-, and high-income countries. Participants were 31,367 respondents to surveys in the World Health Organization's World Mental Health Survey Initiative. The Composite International Diagnostic Interview, version 3.0, was used to derive DSM-IV and DSM-5 lifetime diagnoses of AUD. Clinical characteristics, also assessed in the surveys, included lifetime DSM-IV anxiety; mood and drug use disorders; lifetime suicidal ideation, plan, and attempt; general functional impairment; and psychological distress. RESULTS: Compared with DSM-IV AUD (12.3%, SE = 0.3%), the DSM-5 definition yielded slightly lower prevalence estimates (10.8%, SE = 0.2%). Almost one-third (n = 802) of all DSM-IV abuse cases switched to subthreshold according to DSM-5 and one-quarter (n = 467) of all DSM-IV diagnostic orphans switched to mild AUD according to DSM-5. New cases of DSM-5 AUD were largely similar to those who maintained their AUD across both classifications. Similarly, new DSM-5 noncases were similar to those who were subthreshold across both classifications. The exception to this was with regard to the prevalence of any lifetime drug use disorder. CONCLUSIONS: In this large cross-national community sample, the prevalence of DSM-5 lifetime AUD was only slightly lower than the prevalence of DSM-IV lifetime AUD. Nonetheless, there was considerable diagnostic switching, with a large number of people inconsistently identified across the 2 DSM classifications.

Concordance of ICD-11 and DSM-5 definitions of alcohol and cannabis use disorders: a population survey.

The proposed criteria for alcohol and cannabis use disorders in the 11th edition of ICD (ICD-11) will be presented to the World Health Assembly in 2017, but the beta-phase descriptions have been released. We compared them with those in the tenth edition (ICD-10) and the American Psychiatric Association's DSM fourth edition (DSM-IV) and fifth edition (DSM-5), in a nationally representative sample of adult Australians. Disorders were assessed with the WHO World Mental Health Composite International Diagnostic Interview. The proportions classified as being dependent on alcohol and cannabis were similar with ICD-10, ICD-11, and DSM-IV, whereas for DSM-5, the proportion of lifetime users meeting the criteria for moderate to severe use (most comparable to dependence in the other systems) was far higher. We assessed whether criteria for alcohol and cannabis use described unidimensional syndromes for each, and all definitions seemed to do so. Classification of alcohol and cannabis use disorders, although simplified in ICD-11, was in almost perfect agreement with the classifications of ICD-10 and DSM-IV. With DSM-5, use disorder seemed to capture a different aspect of problematic use and selected a different group of individuals from the other systems. How the newest definitions will become used remains to be seen. The choice of classification might depend on the clinical population of interest.

Cost of diseases related to alcohol consumption in the Brazilian Unified Health System.

OBJECTIVE: To estimate the direct costs associated to outpatient and hospital care of diseases related to alcohol consumption in the Brazilian Unified Health System. METHODS: Attributable populational risks were estimated for the selected diseases related to the use of 25 g/day or more of ethanol (risk consumption), considering a relative risk (RR) ≥ 1.20. The RR estimates were obtained from three meta-analysis. The risk consumption rates of the Brazilian population ≥ 18 years old were obtained by a national survey. Data from the Hospital Information System of SUS (HIS-SUS) were used to estimate the annual costs of the health system with the diseases included in the analysis. RESULTS: The total estimated costs for a year regarding diseases related to risk consumption were U$8,262,762 (US$4,413,670 and US$3,849,092, for outpatient and hospital care, respectively). CONCLUSIONS: Risk consumption of alcohol is an important economic and health problem, impacting significantly the health system and society.

Meta-analysis of DSM alcohol use disorder criteria severities: structural consistency is only 'skin deep'.

BACKGROUND: Item response theory (IRT) analyses of alcohol use disorder (AUD) and other psychological disorders are a predominant method for assessing overall and individual criterion severity for psychiatric diagnosis. However, no investigation has established the consistency of the relative criteria severities across different samples. METHOD: PubMed/Medline, PsycINFO, Web of Science and ProQuest databases were queried for entries relating to alcohol use and IRT. Study data were extracted using a standardized data entry sheet. Consistency of reported criteria severities across studies was analysed using generalizability theory to estimate generalized intraclass correlations (ICCs). RESULTS: A total of 451 citations were screened and 34 papers (30 unique samples) included in the research synthesis. The AUD criteria set exhibited low consistency in the ordering of criteria using both traditional [ICC = 0.16, 95% confidence interval (CI) 0.06-0.56] and generalized (ICC = 0.18, 95% CI 0.15-0.21) approaches. These results were partially accounted for by previously studied factors such as age and type of sample (e.g. clinical v. community), but the largest source of unreliability was the diagnostic instrument employed. CONCLUSIONS: Despite the robust finding of unidimensional structure of AUDs, inconsistency in the relative severities across studies suggests low replicability, challenging the generalizability of findings from any given study. Explicit modeling of well-studied factors like age and sample type is essential and increases the generalizability of findings. Moreover, while the development of structured diagnostic interviews is considered a landmark contribution toward improving psychiatric research, variability across instruments has not been fully appreciated and is substantial.

Cost of diseases related to alcohol consumption in the Brazilian unified health system / Custos de doenças relacionadas ao consumo de álcool no sistema único de saúde

ABSTRACT OBJECTIVE To estimate the direct costs associated to outpatient and hospital care of diseases related to alcohol consumption in the Brazilian Unified Health System. METHODS Attributable populational risks were estimated for the selected diseases related to the use of 25 g/day or more of ethanol (risk consumption), considering a relative risk (RR) ≥ 1.20. The RR estimates were obtained from three meta-analysis. The risk consumption rates of the Brazilian population ≥ 18 years old were obtained by a national survey. Data from the Hospital Information System of SUS (HIS-SUS) were used to estimate the annual costs of the health system with the diseases included in the analysis. RESULTS The total estimated costs for a year regarding diseases related to risk consumption were U$8,262,762 (US$4,413,670 and US$3,849,092, for outpatient and hospital care, respectively). CONCLUSIONS Risk consumption of alcohol is an important economic and health problem, impacting significantly the health system and society.

RESUMO OBJETIVO Estimar os custos diretos associados ao atendimento ambulatorial e hospitalar de doenças relacionadas com o consumo de álcool no Sistema Único de Saúde brasileiro. MÉTODOS Riscos atribuíveis populacionais foram calculados para doenças selecionadas relacionadas ao uso de 25 g/dia ou mais de etanol (consumo de risco), considerando-se o risco relativo (RR) ≥ 1,.20. As estimativas de RR foram obtidas a partir de três meta-análises e as taxas de consumo de risco em brasileiros ≥ 18 anos obtidos em pesquisa nacional. Os dados do Sistema de Informações Hospitalares do SUS (SIH-SUS) e do Sistema de Informações Ambulatoriais do SUS (SIA-SUS) foram utilizados para estimar os custos anuais do SUS com as doenças incluídas na análise. RESULTADOS Os custos totais estimados em um ano com todas as doenças relacionadas com consumo de risco foram US$8.262.762 (US$4.413.670 e US$3.849.092 para pacientes ambulatoriais e internados, respectivamente). CONCLUSÕES Consumo de risco de álcool representa importante problema econômico e de saúde, com um impacto significativo para o sistema de saúde e para a sociedade.

Comparison of DSM-5 Classifications of Alcohol Use Disorders With Those of DSM-IV, DSM-III-R, and ICD-10 in a General Population Sample in Sweden.

OBJECTIVE: The purpose of this study was to employ the criteria for alcohol use disorder (AUD), according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), in a general population sample and to compare the diagnostic classifications and prevalence with those of DSM-IV, DSM-III-R, and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). METHOD: We used a stratified random sample of 1,091 participants (ages 18-64) in Stockholm County, who were interviewed between 1998 and 2002. A semistructured interview was conducted using Schedules for Clinical Assessment in Neuropsychiatry. Diagnoses were made according to DSM-5, DSM-IV, DSM-III-R, and ICD-10. Agreement was studied using Cohen's κ. RESULTS: The prevalence of DSM-5 AUD was 11.0%, with corresponding dependence or abuse/harm diagnosis being 8.7% for DSM-IV, 8.5% for DSM-III-R, and 4.9% for ICD-10. With the shift from DSM-IV to DSM-5, 3.2% of those with no disorder were reclassified as mild AUD, whereas 28.9% of those with DSM-IV abuse were reclassified as having no disorder. The majority of the "new cases" had two DSM-IV dependence criteria, and few endorsed the new DSM-5 craving criteria. Cohen's κ between DSM-5 AUD and dependence or abuse/harm was as follows: DSM-IV, .84, DSM-III-R, .83, and ICD-10, .62. These findings were lower than the κ between the older systems: between DSM-IV and DSM-III-R, .98, between DSM-IV and ICD-10, .70, and between DSM-III-R and ICD- 10, .72. CONCLUSIONS: In the present study population, there were more undiagnosed DSM-IV cases being diagnosed as AUD using DSM-5 than vice versa, but in total the number of cases increased moderately when going from DSM-IV to DSM-5. Concerning reliability, there are substantial to almost perfect agreements between DSM-5 classifications of AUDs and those of DSM-IV, DSM-III-R, and ICD-10.

Latent Class Analysis of DSM-5 Alcohol Use Disorder Criteria Among Heavy-Drinking College Students.

The DSM-5 has created significant changes in the definition of alcohol use disorders (AUDs). Limited work has considered the impact of these changes in specific populations, such as heavy-drinking college students. Latent class analysis (LCA) is a person-centered approach that divides a population into mutually exclusive and exhaustive latent classes, based on observable indicator variables. The present research was designed to examine whether there were distinct classes of heavy-drinking college students who met DSM-5 criteria for an AUD and whether gender, perceived social norms, use of protective behavioral strategies (PBS), drinking refusal self-efficacy (DRSE), self-perceptions of drinking identity, psychological distress, and membership in a fraternity/sorority would be associated with class membership. Three-hundred and ninety-four college students who met DSM-5 criteria for an AUD were recruited from three different universities. Two distinct classes emerged: Less Severe (86%), the majority of whom endorsed both drinking more than intended and tolerance, as well as met criteria for a mild AUD; and More Severe (14%), the majority of whom endorsed at least half of the DSM-5 AUD criteria and met criteria for a severe AUD. Relative to the Less Severe class, membership in the More Severe class was negatively associated with DRSE and positively associated with self-identification as a drinker. There is a distinct class of heavy-drinking college students with a more severe AUD and for whom intervention content needs to be more focused and tailored. Clinical implications are discussed.

[The concept of alcohol craving]. / Koncepcje tzw. glodu alkoholu.

The aim of the article was to assess how the perception of alcohol craving, which is one of the symptoms of alcohol dependence, evolved, as well as how it was reflected in the diagnostic classifications. The purpose of this article was also a discussion of the models of the origins of craving, explaining the etiology of this phenomenon and the tools for measuring this concept. The concept of craving, defined as a strong need or compulsion to drink alcohol, functioned for many years, not only in the clinical practice but also as a concept inherently associated with alcohol dependence. However, among experts and researchers, there was no consensus about the etiology of this phenomenon and its development. Some emphasize the emotional - motivational aspect of it, while in the literature also its cognitive - behavioral nature is highlighted. Craving as a symptom has been recognized as a diagnostic criterion of alcohol dependence in the International Statistical Classification of Diseases and Related Health Problems - ICD 10. In the year 2013, it was also indicated as a symptom of disorder resulting from alcohol abuse in the Diagnostic and Statistical Manual of Mental Disorders - DSM 5. It seems to be significant also to discuss the tools used to measure craving, both in clinical trials and therapeutic practice, among them: the Alcohol Specific Role Play Test, Obsessive Compulsive Drinking Scale (OCDS) Lubeck Craving Scale (LCRR) and Alcohol Urge Questionnaire (AUQ).

Multidimensional alcoholism typologies: could they guide clinical practice? Results from a 3-month prospective study.

OBJECTIVE: The current nosological classifications may describe a syndrome of "alcoholism" that is too heterogeneous to produce prognostic models for clinical management. Multidimensional alcoholism typologies (ATs) could represent a valuable paradigm in the search for targeted treatment. The main goal of this study was to evaluate the clinical implications of 3 empirically-validated ATs, focusing on various measures of clinical performance. METHOD: This was a 3-month naturalistic study in which drinking status, and participation in the clinical protocol and group psychotherapy were recorded and used as indicators of treatment performance. The clinical profiles of the subtypes were also compared and graphically presented. Alcohol-dependent outpatients were classified according to the Cloninger, Lesch, and NETER typologies. RESULTS: The results showed that the type II (Cloninger), type IV (Lesch), and sociopathic and addictopathic (NETER) subgroups showed a worse outcome in terms of abstinence rates and clinical healthcare resource use. CONCLUSIONS: Our findings point to the need to differentiate multidimensional alcoholism subtypes before planning the clinical management of alcohol use disorders.

Dimensionality and stages of severity of DSM-5 criteria in an international sample of alcohol-consuming individuals.

INTRODUCTION: The DSM-5 alcohol use disorder (AUD) criteria proposal contains 11 criteria that include most of the DSM-IV abuse and dependence criteria plus craving. The aims of the current study in a large and international alcohol-consuming sample were to confirm the dimensionality of the DSM-5 AUD criteria and to differentiate grades of severity of DSM-5 AUD in subjects who pass the proposed DSM-5 diagnostic threshold of two criteria. METHOD: We used the World Health Organization (WHO)/International Society on Biomedical Research on Alcoholism (ISBRA) Study on State and Trait Markers of Alcohol Use and Dependence dataset. Subjects included in the analyses were aged ≥ 18 years and were recruited in five countries: Australia, Brazil, Canada, Finland and Japan. Assessment of AUD and additional characteristics was conducted using an adapted version of the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS). Dimensionality of the DSM-5 criteria was evaluated using factor analysis and item response theory (IRT) models. The IRT results led to the classification of AUD patients into three severity groups. External validators were used to differentiate statistically across subgroups. RESULTS: A total of 1424 currently drinking individuals were included in the analyses. Factor and IRT analyses confirmed the dimensional structure of DSM-5 AUD criteria. More than 99% of the subjects could be allocated to one of the suggested severity subgroups. The magnitude of the external validators differed significantly across the severity groups. CONCLUSIONS: The results confirm the dimensional structure of the proposed DSM-5 AUD criteria. The suggested stages of severity (mild, moderate and severe) may be useful to clinicians by grouping individuals not only in the mild but also in the moderate to severe spectrum of DSM-5 AUD.