Skip to main content
Full access
Letter to the Editor
Published Online: 1 December 2005

Validity of the One-Criterion Threshold for an Alcohol Abuse Diagnosis

To the Editor: We were surprised to read the results of the article by Marc A. Schuckit, M.D., et al. (1). The authors concluded that all four DSM-IV alcohol abuse criteria perform equally well and that their results favored the threshold of one criterion for the diagnosis of alcohol abuse. This is remarkable because the validity of the abuse category has been one of the main controversies of the DSM-IV classification for alcohol use disorders (e.g., reference 2). We have serious reservations regarding the validity of the data of Dr. Schuckit et al. and their subsequent justification of the one-criterion threshold for alcohol abuse.
First, the study group in the article by Dr. Schuckit et al. was rather unusual, with more than 70% of the subjects being relatives of treatment-seeking alcoholics. This limited the generalizability of their findings. For example, in our recent study of a large general population sample (N=7,076) (3), subjects with a DSM-IV diagnosis of alcohol abuse could not be differentiated from subjects without a DSM-IV alcohol use disorder diagnosis with a broad range of external validators (e.g., psychiatric comorbidity, functional status, familial alcohol problems, treatment seeking). Subjects with two or more criteria, however, were significantly different from subjects without a DSM-IV alcohol use disorder, indicating better validity for a threshold of at least two criteria (3).
Second, most of the validators for the DSM-IV diagnosis of alcohol abuse in the article by Dr. Schuckit et al. are rather weak. The fact that subjects with abuse had a higher intake of alcohol than the subjects without an alcohol use disorder is hardly surprising and almost tautological. When the authors looked at drug-related history to compare subjects with one-criterion abuse to subjects without an alcohol use disorder, they did mention drug use (significant difference for cocaine use only) but failed to mention the more relevant prior history of drug abuse or dependence.
Third, when evaluating the 5-year outcome, the authors seemed to ignore the fact that over 70% of the subjects with a DSM-IV diagnosis of abuse at baseline did not endorse any abuse criterion at follow-up. In our general population study, even higher rates of spontaneous remission of DSM-IV alcohol abuse were observed: 81% and 85% at the 1- and 3-year follow-ups, respectively (unpublished report). In a prospective evaluation of the validity of current DSM-IV abuse criteria, these findings should at least be discussed.
In summary, we feel that the limitations of the study by Dr. Schuckit et al. call for a more cautious interpretation and that their findings cannot simply be used as support for the validity of the one-criterion threshold for the diagnosis of alcohol abuse.

References

1.
Schuckit MA, Smith TL, Danko GP, Kramer J, Godinez J, Bucholz KK, Nurnberger JI Jr, Hesselbrock V: Prospective evaluation of the four DSM-IV criteria for alcohol abuse in a large population. Am J Psychiatry 2005; 162:350–360
2.
Hasin DS, Schuckit MA, Martin CS, Grant BF, Bucholz KK, Helzer JE: The validity of DSM-IV alcohol dependence: what do we know and what do we need to know? Alcohol Clin Exp Res 2003; 27:244–252
3.
de Bruijn C, van den Brink W, de Graaf R, Vollebergh WA: The craving withdrawal model for alcoholism: towards the DSM-V: improving the discriminant validity of alcohol use disorder diagnosis. Alcohol Alcohol 2005; 40:314–322

Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 2400
PubMed: 16330621

History

Published online: 1 December 2005
Published in print: December 2005

Authors

Details

CARLA de BRUIJN, M.D., Ph.D.
WIM van den BRINK, M.D., Ph.D.
Utrecht, the Netherlands

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard

View Options

View options

PDF/EPUB

View PDF/EPUB

Get Access

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login
Purchase Options

Purchase this article to access the full text.

PPV Articles - American Journal of Psychiatry

PPV Articles - American Journal of Psychiatry

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share