This article is more than 5 years old. Information may no longer be current.

DSM changes unlikely to affect prevalence of alcohol-related diagnoses

Diagnostic changes in the DSM-5— namely, collapsing the two diagnoses of alcohol abuse and alcohol dependence into a single category of alcohol use disorder —are unlikely to significantly increase the prevalence of alcohol-related diagnoses, according to new study results published today in Alcoholism: Clinical and Experimental Research.

“Clinicians might see a slight change in the number of people who meet diagnostic criteria for alcohol problems, and this shift is likely to disproportionately affect women,” study researcher Alexis C. Edwards, PhD, assistant professor in the department of psychiatry at Virginia Commonwealth University School of Medicine, told Psychiatric Annals.  “However, the changes shouldn’t be dramatic. Our results indicate that the new diagnosis — ‘alcohol use disorder’ — will still pick up on individuals with a genetic liability toward alcohol problems (ie, a family history).”

Edwards and colleagues studied a population-based sample of adult twins (n=7,454) assessed for lifetime alcohol abuse and alcohol dependence to examine phenotypic differences across the DSM-IV and DSM-5. Craving, an additional criterion in DSM-5, was not included in the analysis because of its exclusion from the fourth edition.

Nearly one-third (30.6%) of the sample met criteria for either alcohol abuse or alcohol dependence, and most adults (88.8%) with alcohol dependence also endorsed at least one symptom of alcohol abuse. There was a slightly larger proportion (32.1%) of adults who met lifetime DSM-5 alcohol use disorder criteria. The increase was more pronounced among women (16.9% to 18.8%) vs. men (41.4% to 42.7%), although the proportions were higher among men. Of those adults who met DSM-5 criteria for alcohol use disorder, 38.3% could be classified as having moderate alcohol use disorder, with the remainder of adults having severe alcohol use disorder.

Previous study results also have indicated only a modest increase in the 12-month prevalence across the diagnoses.

Among those adults receiving a DSM-IV diagnosis, 7.6% would be excluded from having a DSM-5 diagnosis, according to the researchers.

Adults who met DSM-IV or DSM-5 criteria — but not both — had fewer comorbid diagnoses, such as major depression, generalized anxiety disorder and conduct disorder, compared with adults who met criteria for both DSM-IV and DSM-5 (P<.01). Results also indicated that adults meeting only DSM-IV criteria exhibited slightly, but not significantly, more severe symptoms than those who met only DSM-5 criteria.

Other changes in the upcoming DSM-5include the removal of “legal problems” from the diagnosis. Further analysis indicated that the criterion loading was the lowest of all symptoms and has low discriminatory power.

According to Edwards and colleagues, the removal of the legal problems criterion should not negatively affect the DSM-5’s diagnostic validity.

The researchers also found that the genetic liability for alcohol use disorder in the DSM-5 was largely consistent with criteria in the fourth edition, but that the genetic correlation between diagnoses in the two editions was slightly but significantly lower than unity (P<.01).

“DSM-IV criteria should continue to be considered important and useful indicators of problems,” Edwards said. “Most people who meet those criteria will also meet DSM-5 criteria.”

Disclosure: The researchers report no relevant financial disclosures.