A five-year prospective study of diagnostic orphans for alcohol use disorders.

Diagnostic orphans for alcohol use disorders in a treatment-seeking psychiatric sample

“…In an adolescent sample, diagnostic orphans were more similar to patients with AB than to those with AD and no-AUD on alcohol use patterns, substance use, and substance-related diagnoses (Pollock and Martin, 1999). Similar findings were reported in a sample of individuals deemed at risk for the development of AUD (Sarr et al, 2000) and in a longitudinal study of sons of alcohol dependent parents and controls (Eng et al, 2003), such that diagnostic orphans more closely resembled individuals with AB than those with AD or no-AUD on measures of drinking and substance use. Conversely, diagnostic orphans differed significantly from individuals with AD in community (Hasin and Paykin, 1998) and nationally-representative (Hasin and Paykin, 1999) samples by reporting lower alcohol use, drug use, and family history of alcoholism.…”

“…Most notably, diagnostic orphans were less likely to meet lifetime criteria for various substance use disorders, as compared to patients with AB and AD. These results suggest that in general psychiatric practice, diagnostic orphans may be more dissimilar to alcohol abusers than what was reported in non-treatment seeking adult (Eng et al, 2003) and adolescent (Pollock and Martin, 1999) samples, and generally do not support combining adult diagnostic orphans to patients with AB.…”

“…The AD symptoms most frequently endorsed by diagnostic orphans were: drinking more than intended (39.7%), tolerance (33.3%), and spending a great deal of time drinking (28.4%), with the first two symptoms also commonly endorsed in previous studies (Eng et al, 2003;Hasin and Paykin, 1998;Sarr et al, 2000). Item Response Theory (IRT) analyses of MIDAS patients endorsing ≥ 1 AUD symptom revealed that the three most frequently endorsed symptoms by diagnostic orphans in this study had the lowest severity estimates (Ray et al, under review).…”

“…The findings regarding cannabis dependence are intriguing, as a previous study of adolescents found no significant differences in the prevalence of lifetime DSM-IV cannabis use disorders among diagnostic orphans and drinkers with no-AUD (Pollock and Martin, 1999). By contrast, a longitudinal study of adults suggested that the drug use histories of diagnostic orphans fell between the histories of the no-AUD and AB groups (Eng et al, 2003). This study provided more fine-grained analyses of various substance use disorders and suggested that diagnostic orphans are 3.43 times more likely to meet DSM-IV lifetime criteria for cannabis dependence as compared to those with no-AUD.…”

Psychometric properties of DSM assessments of illicit drug abuse and dependence: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

“…7% and 41 . 1% for alcohol (Pollock & Martin, 1999 ;Sarr et al 2000 ;Eng et al 2003) and an estimated 21 % for cannabis (Degenhardt et al 2002). While, to the best of our knowledge, no previous study has examined the prevalence and characteristics of ' diagnostic orphans ' for other illicit substance use, the consistency of findings between alcohol and cannabis suggests that a substantial proportion of people meeting at least one criteria for an illicit drug problem may be labeled as 'diagnostic orphans' and that such individuals may be at heightened risks for drugrelated and other mental health problems, relative to individuals experiencing no abuse or dependence criteria.…”