Differentiating DSM-IV alcohol dependence and abuse by course: Community heavy drinkers

Hasin, Deborah S.; Rossem, Ronan Van; McCloud, Steven; Endicott, Jean

doi:10.1016/s0899-3289(97)90011-0

Cited by 125 publications

(97 citation statements)

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“…Although both factor and latent class models have been previously used to explain the population aggregation of AD symptoms (Allen et al, 1993), no clear structure has emerged. A FA approach seeks to understand the underlying continuous dimensions for symptoms, which is an important initial stage of developing constructs in the use or abuse either of a single substance (Harford and Muthen, 2001;Hasin et al, 1997;Lennox et al, 1996) or of a variety of substance disorders (Nelson et al, 1999) but is more difficult to provide direct clinical applications, such as treatment response and evaluation. While LCA models frequently support a severity-based classification in alcohol problems (Bucholz et al, 1996;Lynskey et al, 2005) or cannabis use , the symptom profiles from these analyses appear largely parallel, and involve relatively small differences in item endorsement probability.…”

Section: Discussionmentioning

confidence: 99%

“…While it is still in debate whether abuse should be included in the same continuum as dependence, AD appears to be a more reliable unitary construct. In addition, two prospective studies used general population samples have indicated that the course of AD differs from that of abuse (Hasin et al, 1990;Hasin et al, 1997), and implied that alcohol dependence and abuse are different in nature. Because alcohol abuse and dependence also have different features in terms of their clinical presentation, etiology and demographic characteristics (Hasin et al, 2007), we focus on only alcohol dependence for the present study.…”

Section: Introductionmentioning

confidence: 99%

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Using a factor mixture modeling approach in alcohol dependence in a general population sample

Kuo

Aggen

Prescott

et al. 2008

Drug and Alcohol Dependence

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Alcohol dependence (AD) is a complex and heterogeneous disorder. The identification of more homogeneous subgroups of individuals with drinking problems and the refinement of the diagnostic criteria are inter-related research goals. They have the potential to improve our knowledge of etiology and treatment effects, and to assist in the identification of risk factors or specific genetic factors. Mixture modeling has advantages over traditional modeling that focuses on either the dimensional or categorical latent structure. The mixture modeling combines both latent class and latent trait models, but has not been widely applied in substance use research. The goal of the present study is to assess whether the AD criteria in the population could be better characterized by a continuous dimension, a few discrete subgroups, or a combination of the two. More than seven thousand participants were recruited from the population-based Virginia Twin Registry, and were interviewed to obtain DSM-IV (Diagnostic and Statistical Manual of Mental Disorder, version IV) symptoms and diagnosis of AD. We applied factor analysis, latent class analysis, and factor mixture models for symptom items based on the DSM-IV criteria.Our results showed that a mixture model with one factor and three classes for both genders fit well. The three classes were a non-problem drinking group and severe and moderate drinking problem groups. By contrast, models constrained to conform to DSM-IV diagnostic criteria were rejected by model fitting indices providing empirical evidence for heterogeneity in the AD diagnosis. Classification analysis showed different characteristics across subgroups, including alcohol-caused behavioral problems, comorbid disorders, age at onset for alcohol-related milestones, and personality. Clinically, the expanded classification of AD may aid in identifying suitable treatments, interventions and additional sources of comorbidity based on these more homogenous subgroups of alcohol use problems.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using a factor mixture modeling approach in alcohol dependence in a general population sample

Kuo

Aggen

Prescott

et al. 2008

Drug and Alcohol Dependence

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“…The reliability of the AUDADIS-IV alcohol diagnoses is documented in clinical and general population samples Grant et al, 2003a;Hasin et al, 1997a) with test retest reliability ranging from good to excellent (κ = 0.70-0.84). Convergent, discriminant, and construct validity of AUDADIS-IV alcohol use disorder criteria and diagnoses were good to excellent (Hasin and Paykin, 1999;Hasin et al, 1990Hasin et al, , 1994Hasin et al, , 2003Hasin et al, , 1997c, including in the World Health Organization/National Institutes of Health International Study on Reliability and Validity Hasin et al, 1997b;Nelson et al, 1999;Pull et al, 1997;Ustun et al, 1997;Vrasti et al, 1998), where clinical reappraisals documented good validity of DSM-IV alcohol use disorder diagnoses (κ = 0.60-0.76) (Canino et al, 1999;Cottler et al, 1997;Hasin et al, 1997b;Nelson et al, 1999;Pull et al, 1997;Ustun et al, 1997;Vrasti et al, 1998).…”

Section: Source Of Datamentioning

confidence: 99%

Generalizability of clinical trials for alcohol dependence to community samples

Blanco

Olfson

Okuda

et al. 2008

Drug and Alcohol Dependence

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There is a growing concern that results of tightly controlled clinical trials of individuals with alcohol use disorders may not generalize to broader community samples. To assess the proportion of community-dwelling adults with alcohol dependence who would have been eligible for a typical alcohol dependence treatment study, we developed a new, simple method: we applied a standard set of eligibility criteria commonly used in alcohol outcome studies to a large (n = 43,093) representative US adult sample interviewed face-to-face, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We found that approximately one-half (50.5%) of all individuals with a DSM-IV diagnosis of alcohol dependence (n = 1484) and 79.4% of those who sought treatment (n = 185) were excluded by one or more study criteria. Individual study criteria excluded from 0.9% to 48.2% of the overall sample and 0.8% to 43.7% of the treatment-seeking sample. For the overall sample, the lack of motivation/compliance and financial situation criteria excluded the largest percentage of individuals. In the treatment-seeking subsample, comorbid medical conditions and legal problems excluded the largest proportions of individuals. Our study provides a new method to assess the generalizability of clinical trials, and gives further evidence that typical clinical trials for alcohol dependence likely exclude most adults with the disorder in the community and under care, and support the notion that clinical trials recruit "pure" rather than "typical" patients. Clinical trials should carefully evaluate the effects of the selected eligibility criteria on the generalizability of their results.

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“…DSM-IV nomenclature suggests that abuse should occur before dependence (pertaining to the same drug) and that only a subset of persons who experience abuse should advance to experience dependence (APA, 1994). Both of these expectations regarding the association between abuse and dependence diagnoses have been refuted empirically (Hasin & Grant, 2004;Hasin, Van Rossem, McCloud, & Endicott, 1997;Ridenour et al, 2003;Schuckit et al, 2001). Ridenour et al (2003) argued that the environmental element of each abuse criterion makes them impure measures of individuals' drug misuse.…”

Section: Obstacles Of Human Addiction Diagnostic Phenotypesmentioning

confidence: 99%

Different lengths of times for progressions in adolescent substance involvement

Ridenour

Lanza

Donny

et al. 2006

Addictive Behaviors

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The present study examined Lengths Of Times for important transitions in substance involvement from Initiation to Regular use (LOTIR), first Problem from drug use (LOTIP), and first experience of Dependence (LOTID) for alcohol, tobacco, cannabis, cocaine, and opiates. Data were from a longitudinal study of 590 children (22.2% female) at different levels of risk for substance use disorders based on their fathers' substance use-related diagnoses. Participants' substance involvement was assessed at four ages: 10-12, and follow-ups at two, five, and eight years later. Results suggested that faster transitions were more due to drug-related constructs (including possible social milieus of different drug classes and interactions between drug class and neurophysiology) than intrapersonal constructs. The shortest transition times (and greatest addictive liabilities) were for opiates followed respectively by cocaine, cannabis, tobacco, and alcohol. Females had shorter transition times, though gender differences were small. Some evidence was found for a familial influence on transition times above what was accounted for by differences between substances.

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Differentiating DSM-IV alcohol dependence and abuse by course: Community heavy drinkers

Abstract: The purpose of this study was to investigate the differences in shortterm course between DSM-IV alcohol abuse and alcohol dependence in a community

Cited by 125 publications

References 12 publications

Using a factor mixture modeling approach in alcohol dependence in a general population sample

Using a factor mixture modeling approach in alcohol dependence in a general population sample

Generalizability of clinical trials for alcohol dependence to community samples

Different lengths of times for progressions in adolescent substance involvement

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