The dimensionality of alcohol use disorders: Results from Israel

Abstract

Aims To prepare for DSM-V, the structure of DSM-IV alcohol dependence and abuse criteria and a proposed additional criterion, at-risk drinking, require study in countries with low per-capita consumption, and comparison of current and lifetime results within the same sample. We investigated DSM-IV Alcohol Use Disorder (AUD) criteria in Israel, where per-capita alcohol consumption is low. Methods Household residents selected from the Israeli population register (N=1,338) were interviewed with the AUDADIS. Item Response Theory analyses were conducted using MPlus, and diagnostic thresholds examined with the kappa statistic. Results Dependence and abuse criteria fit a unidimensional model interspersed across the severity continuum, for both current and lifetime timeframes. Legal problems were rare and did not improve model fit. Weekly at-risk drinking reflected greater severity than in U.S. samples. When dependence and abuse criteria were combined, a diagnostic threshold of ≥3 criteria produced the best agreement with DSM-IV diagnoses (kappa>0.80). Conclusion Consistent with other studies, alcohol dependence and abuse criteria reflected a latent variable representing a single AUD. Results suggested little effect in removing legal problems and little gained by adding weekly at-risk drinking. Results contribute to knowledge about AUD criteria by examining them in a low-consumption country.

Nosologic Comparisons of DSM-IV and DSM-5 Alcohol and Drug Use Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions–III

“…The combination of abuse and dependence into a single diagnosis reflected substantial evidence from factor and item response theory (IRT) analyses supporting a single latent construct underlying all DSM-IV SUDs, with abuse and dependence criteria always intermixed along the severity spectrum (e.g., Compton et al, 2009;Mewton et al, 2011;Saha et al, 2006Saha et al, , 2007Saha et al, , 2010Saha et al, , 2012Shmulewitz et al, 2010). Additional considerations included the well-documented reliability (Hasin et al, 2006a) and validity Dawson et al, 2000;Grant et al, 2004;Hasin et al, 2007) of dependence but less desirable psychometric properties of abuse.…”

Alcohol Consumption Mediates the Relationship Between ADH1B and DSM-IV Alcohol Use Disorder and Criteria

“…Interviewers received structured training and administered face-to-face computer-assisted interviews after obtaining written informed consent, as approved by relevant American and Israeli institutional review boards (Shmulewitz et al, 2010). Interviews were administered in Hebrew or Russian.…”

“…The Israeli Population Register comprises household residents in all areas of Israel; potential respondents were selected from the registry based on their demographic characteristics and to provide diversity in their area of residence. Men were oversampled, as drinking among Israeli women is limited (Shmulewitz et al, 2010). Participants of Jewish ethnicity were selected to provide sample homogeneity for the genetic research questions.…”

“…Data were collected in 2007-2009 from 1,349 Jewish adult household residents, as described in detail previously (Hasin et al, 2002a(Hasin et al, , 2002bShmulewitz et al, 2010Shmulewitz et al, , 2012. The sample was designed to investigate environmental and genetic infl uences on alcohol-related traits.…”

“…Third, for those criteria signifi cantly associated with ADH1B, we assessed whether ADH1B acted on these criteria through alcohol consumption. This study used data from a large general population sample of Israeli Jews (Shmulewitz et al, 2010(Shmulewitz et al, , 2012, where we previously showed a strong association between ADH1B and other alcohol phenotypes including alcohol dependence, AUDs, and AUD severity (Meyers et al, 2013).…”