DSM-IV to DSM-5: the impact of proposed revisions on diagnosis of alcohol use disorders
Article first published online: 18 AUG 2011
© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction
Volume 106, Issue 11, pages 1935–1943, November 2011
How to Cite
Agrawal, A., Heath, A. C. and Lynskey, M. T. (2011), DSM-IV to DSM-5: the impact of proposed revisions on diagnosis of alcohol use disorders. Addiction, 106: 1935–1943. doi: 10.1111/j.1360-0443.2011.03517.x
- Issue published online: 6 OCT 2011
- Article first published online: 18 AUG 2011
- Accepted manuscript online: 1 JUN 2011 06:05AM EST
- Submitted 4 March 2011; initial review completed 26 April 2011; final version accepted 19 May 2011
- alcohol use disorders;
- drinking and driving;
- hazardous use;
Aims To determine the prevalence of past 12-month DSM-5 alcohol use disorders (AUDs), to quantify and characterize individuals who remain stably unaffected or affected and those who ‘switch’ diagnostically between DSM-IV and DSM-5 classifications.
Design Data from the nationally representative wave 2 of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) collected in 2004–05.
Setting General population survey.
Participants All surveyed participants (n = 34 653, aged 21 years and older) and 29 993 individuals reporting life-time alcohol use across both waves of NESARC.
Measurements DSM-IV and DSM-5 criteria were coded using proposed guidelines.
Findings The prevalence of DSM-5 AUDs was 10.8% with the corresponding prevalence of DSM-IV abuse/dependence being 9.7%, implying a modest 11.3% increase. Those who switched diagnostically from affected to unaffected (19.6% of DSM-IV affected) were most likely to have endorsed hazardous use, due particularly to drinking and driving, while those who transitioned from unaffected to affected (3.3% of DSM-IV unaffected) were primarily DSM-IV diagnostic orphans reporting larger/longer and quit/cut-back. Dropping the legal criterion did not affect the prevalence significantly, while the addition of craving also had a relatively modest impact on prevalence.
Conclusion The proposed DSM-5 revisions eliminate successfully individuals diagnosed previously with DSM-IV alcohol abuse due primarily to hazardous use alone and incorporate diagnostic orphans into the diagnostic realm. Definitions of craving and importantly, hazardous use require considerable attention as it is likely that they will contribute to variations in reports of increased prevalence of alcohol use disorders between DSM-IV to DSM-5.