Dsm 5 alcohol abuse
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DSM-5 Alcohol Use Disorder: Prevalence, Diagnostic Changes, and Implications
Prevalence of DSM-5 Alcohol Use Disorder
The prevalence of Alcohol Use Disorder (AUD) as defined by the DSM-5 criteria is notably high. According to the National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III), the 12-month and lifetime prevalences of AUD are 13.9% and 29.1%, respectively. These rates are higher among men, white and Native American individuals, younger adults, and those who are previously or never married1. The DSM-5 criteria have led to a modest increase in the prevalence of AUD compared to DSM-IV, primarily due to the inclusion of individuals who were previously classified as "diagnostic orphans" under DSM-IV3 5 6.
Diagnostic Changes from DSM-IV to DSM-5
The transition from DSM-IV to DSM-5 introduced several key changes in the diagnostic criteria for AUD. The DSM-5 criteria combine the DSM-IV categories of alcohol abuse and dependence into a single disorder with varying levels of severity (mild, moderate, severe). This change has resulted in a slight increase in the overall prevalence of AUD diagnoses2 4 7. The DSM-5 criteria also include a new criterion for craving and exclude the legal problems criterion, which has had minimal impact on the overall prevalence rates5 6 7.
Concordance and Reliability of DSM-5 Criteria
Studies have shown substantial to almost perfect agreement between DSM-5 and DSM-IV classifications of AUD. The concordance between DSM-5 and DSM-IV criteria is high, with Cohen's kappa values indicating strong agreement4. However, there is some diagnostic switching, with a significant number of individuals being reclassified under the new criteria. For instance, many individuals who were previously undiagnosed under DSM-IV are now classified as having mild AUD under DSM-54 9.
Comorbidity and Disability Associated with DSM-5 AUD
DSM-5 AUD is highly comorbid with other psychiatric disorders, including major depressive disorder, bipolar I disorder, and various personality disorders. The odds ratios for these associations range from 1.2 to 6.4, indicating a strong link between AUD and other mental health conditions1. Additionally, AUD is associated with significant disability, which increases with the severity of the disorder1.
Implications for Treatment and Public Health
Despite the high prevalence and significant disability associated with DSM-5 AUD, treatment rates remain low. Only 19.8% of individuals with lifetime AUD have ever received treatment1. This highlights the urgent need for public education, destigmatization of the disorder, and the promotion of treatment options. The changes in diagnostic criteria also necessitate adjustments in screening and intervention strategies to better identify and support individuals with AUD2 6.
Conclusion
The DSM-5 criteria for Alcohol Use Disorder have led to a modest increase in the prevalence of the disorder, primarily by capturing individuals who were previously undiagnosed under DSM-IV. The new criteria show high concordance with DSM-IV and are associated with significant comorbidity and disability. Despite these challenges, treatment rates remain low, underscoring the need for enhanced public health initiatives and treatment strategies.
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Most relevant research papers on this topic
Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III.
Alcohol use disorder (AUD) is highly prevalent, highly comorbid, and often untreated in the United States, with significant disability and comorbidity.
Observational Study
Highly CitedNosologic Comparisons of DSM-IV and DSM-5 Alcohol and Drug Use Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III.
DSM-5 substance use disorders have lower lifetime prevalences than DSM-IV disorders, with higher prevalences at 3+ criteria for cannabis, cocaine, and stimulants.
Observational StudyFrom DSM-IV to DSM-5 alcohol use disorder: an overview of epidemiological data.
DSM-5 diagnostic criteria may inflate prevalence rates of alcohol use disorder compared to DSM-IV, potentially due to the increased likelihood of a diagnosis due to the number of DSM-IV 'diagnostic orphans'.
Systematic ReviewComparison of DSM-5 Classifications of Alcohol Use Disorders With Those of DSM-IV, DSM-III-R, and ICD-10 in a General Population Sample in Sweden.
The DSM-5 classification of alcohol use disorder (AUD) is more reliable than the DSM-IV, DSM-III-R, and ICD-10, with moderate increase in cases when going from DSM-IV to DSM-5.
Observational StudyPrevalence of DSM-IV and DSM-5 alcohol, cocaine, opioid, and cannabis use disorders in a largely substance dependent sample.
The DSM-5 has a modestly greater prevalence for Substance Use Disorders (SUDs) due to its ability to capture diagnostic orphans, but other changes in the manual had minimal impact on the prevalence of SUD diagnoses in this sample.
Observational StudyHighly CitedDSM-IV to DSM-5: the impact of proposed revisions on diagnosis of alcohol use disorders.
The proposed DSM-5 revisions eliminate alcohol abuse due to hazardous use and incorporate diagnostic orphans, but definitions of craving and hazardous use require further attention to accurately report the prevalence of alcohol use disorders.
Observational Study
Rigorous JournalHighly CitedAnalyses related to the development of DSM-5 criteria for substance use related disorders: 2. Proposed DSM-5 criteria for alcohol, cannabis, cocaine and heroin disorders in 663 substance abuse patients.
Combining abuse and dependence into a single diagnosis in the DSM-5 is supported, but legal problems should be left out.
Observational StudyHighly CitedDSM-IV and DSM-5 alcohol use disorder among young Swiss men.
The new DSM-5 criteria for alcohol use disorder slightly lower the prevalence of dependence and abuse in young Swiss men, with 63.9% meeting both criteria.
Observational StudyRigorous JournalA Cross-National Examination of Differences in Classification of Lifetime Alcohol Use Disorder Between DSM-IV and DSM-5: Findings from the World Mental Health Survey.
The prevalence of DSM-5 lifetime alcohol use disorder is slightly lower than DSM-IV lifetime alcohol use disorder, but there is considerable diagnostic switching, with many people inconsistently identified across the 2 classifications.
Observational Study
Very Rigorous JournalTaxometric analysis of DSM-IV and DSM-5 alcohol use disorders.
DSM-IV and DSM-5 alcohol use disorders show a hybrid taxonic-dimensional structure, with distinct taxonomic categories for disorders defined by 4 or more criteria, but dimensional variation in non-problematic cases.
Observational Study