Towards the characterization and validation of alcohol use disorder subtypes: integrating consumption and symptom data

Abstract

Background There is evidence that measures of alcohol consumption, dependence and abuse are valid indicators of qualitatively different subtypes of alcohol involvement yet also fall along a continuum. The present study attempts to resolve the extent to which variations in alcohol involvement reflect a difference in kind versus a difference in degree. Method Data were taken from the 2001–2002 National Epidemiologic Survey of Alcohol and Related Conditions. The sample (51% male; 72% white/non-Hispanic) included respondents reporting past 12-month drinking at both waves (wave 1: n=33644; wave 2: n=25186). We compared factor mixture models (FMMs), a hybrid of common factor analysis (FA) and latent class analysis (LCA), against FA and LCA models using past 12-month alcohol use disorder (AUD) criteria and five indicators of alcohol consumption reflecting frequency and heaviness of drinking. Results Model comparison revealed that the best-fitting model at wave 1 was a one-factor four-class FMM, with classes primarily varying across dependence and consumption indices. The model was replicated using wave 2 data, and validated against AUD and dependence diagnoses. Class stability from waves 1 to 2 was moderate, with greatest agreement for the infrequent drinking class. Within-class associations in the underlying latent factor also revealed modest agreement over time. Conclusions There is evidence that alcohol involvement can be considered both categorical and continuous, with responses reduced to four patterns that quantitatively vary along a single dimension. Nosologists may consider hybrid approaches involving groups that vary in pattern of consumption and dependence symptomatology as well as variation of severity within group.

An Empirically Based Typology of Alcohol Users in a Community Sample Using Latent Class Analysis

“…The present study explored subgroups of past-year alcohol users in a nationally representative [13] and Castaldelli-Maia et al [12], and to the 'Non-problematic class' reported by Casey et al [4], or the 'Baseline/Very Mild consumption' reported by Smith and Shelvin [17]. 'Alcohol drinkers with low risk of dependence' demonstrated similar characteristics to the 'Minimally dependent drinkers' reported by Jackson et al [10] and the 'Moderate risk' group reported by Sacco et al [15]. 'Alcohol drinkers with severe dependence symptoms' had comparable symptom profiles to the 'High symptomatic class' reported by Ko et al [13] and Castaldelli-Maia et al [12], and to the 'Extreme class' reported by Casey et al [4], and to the subgroup of 'Heavy consumption with multiple negative consequences' reported by Smith and Shelvin [17].…”

“…Other typologies suggested that AUD can be examined on a continuum of severity, including subgroups that are likely to vary from each other quantitatively. This latter approach corresponds with the unidimensional concept in the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [9,10].…”

“…By including non-treatment seeking individuals in classification models, they could more accurately represent the less severe forms of AUD [5,11]. Various studies which have used general population or community-based samples have identified severity-based subgroups of drinkers [4,10,[12][13][14][15]. Here, each of the latent classes demonstrated quantitatively different item endorsement profiles on the indicators of alcohol consumption, dependence symptoms, and negative social consequences.…”

Working memory ability and early drug use progression as predictors of adolescent substance use disorders

“…The scores for the three drugs were significantly correlated ( r = 0.22–0.44). Further, given the co-morbidity in early-onset SUD [39] and research suggesting a single underlying factor for consumption, dependence, and abuse [40], we used a latent factor with the criterion scores of alcohol, marijuana, and tobacco as our outcome variable. Confirmatory factor analyses revealed that the criterion scores loaded on a single latent factor, with loadings ranging from 0.31–0.65.…”

Latent classes of alcohol problems in Mauritian men: Results from the Joint Child Health Project

“…In a previous study of the JCHP sample assessed during childhood , we found Creole parents endorsed higher levels of problems in their children that were more similar to rates in the US than did Hindu and Muslim parents. Additional research is needed to better understand why Creoles are more likely to be in the Moderate class; examining alcohol consumption levels in relation to problems may help shed light on these differences .…”