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Limitations of DSM-IV Operationalizations of Alcohol Abuse and Dependence in a Sample of Australian Twins

Published online by Cambridge University Press:  21 February 2012

Michael T. Lynskey*
Affiliation:
Queensland Institute of Medical Research, Brisbane, Queensland, Australia; Missouri Alcoholism Research Center and Department of Psychiatry,Washington University School of Medicine, St Louis, Missouri, United States of America. Mlynskey@matlock.wustl.edu
Elliot C. Nelson
Affiliation:
Missouri Alcoholism Research Center and Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, United States of America.
Rosalind J. Neuman
Affiliation:
Missouri Alcoholism Research Center and Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, United States of America.
Kathleen K. Bucholz
Affiliation:
Missouri Alcoholism Research Center and Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, United States of America.
Pamela A. F. Madden
Affiliation:
Missouri Alcoholism Research Center and Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, United States of America.
Valerie S. Knopik
Affiliation:
Missouri Alcoholism Research Center and Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, United States of America.
Wendy Slutske
Affiliation:
Missouri Alcoholism Research Center and Department of Psychology, University of Missouri, Columbia, Missouri, United States of America.
John B. Whitfield
Affiliation:
Queensland Institute of Medical Research, Brisbane, Queensland, Australia; Royal Prince Alfred Hospital, Sydney, Australia.
Nicholas G. Martin
Affiliation:
Queensland Institute of Medical Research, Brisbane, Queensland, Australia.
Andrew C. Heath
Affiliation:
Missouri Alcoholism Research Center and Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, United States of America.
*
*Address for correspondence: Michael T. Lynskey, PhD, Mid-West Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, 660 S Euclid, Box 8134, St Louis, MO 63110, USA.

Abstract

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Alcohol abuse and dependence are among the most common psychiatric conditions identified in epidemiological surveys of the general population. The aim of this article is to examine the psychometric properties of Diagnostic and Statistical Manual of Mental Disorders, (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria for alcohol abuse and dependence using latent class analysis (LCA). Six thousand two hundred and sixty-five young Australian twins (median age 30 years) were interviewed by telephone between 1996 and 2000 using a modified version of the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). DSM-IV symptoms of alcohol abuse and dependence were collected by structured diagnostic interview and analyzed using methods of LCA. LCA revealed a 4-class solution for women that classified individuals according to the severity of their alcohol- related problems: no/few problems (66.5%), heavy drinking (23.9%), moderate dependence (7.6%) and severe dependence (2.0%). Among men the preferred solution included 5 classes corresponding to no/few problems (46.4%), heavy drinking (34.3%), moderate dependence (12.2%), severe dependence (3.0%) and abuse (4.0%). Evidence of a male-specific class of alcohol-related problems corresponding to abuse partially supports the DSM conceptualization of alcohol use disorders but suggests that this conceptualization — and measurement — may need to be refined for women. Identification of a male- specific abuse class also has important implications for interventions and treatment as these individuals experienced significant alcohol-related problems and comprised approximately 21% of all men classified with an alcohol use disorder.

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Copyright © Cambridge University Press 2005
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