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Alcohol craving and the dimensionality of alcohol disorders

Published online by Cambridge University Press:  12 May 2010

K. M. Keyes ,
R. F. Krueger ,
B. F. Grant  and
D. S. Hasin
K. M. Keyes
Affiliation:
New York State Psychiatric Institute, New York, NY, USA Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
R. F. Krueger
Affiliation:
Department of Psychology and Psychiatry, Washington University in St Louis, St Louis, MO, USA
B. F. Grant
Affiliation:
Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
D. S. Hasin*
Affiliation:
New York State Psychiatric Institute, New York, NY, USA Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
*
*Address for correspondence: D. S. Hasin, Ph.D., New York State Psychiatric Institute, 1051 Riverside Drive #123, New York, New York 10032, USA. (Email: dsh2@columbia.edu)
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Abstract

Background

ICD-10 includes a craving criterion for alcohol dependence while DSM-IV does not. Little is known about whether craving fits with or improves the DSM-IV criteria set for alcohol-use disorders.

Method

Data were derived from current drinkers (n=18 352) in the 1991–1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES), a nationally representative survey of US adults >17 years of age. The Alcohol Use Disorder and Associated Disabilities Interview Schedule was used to assess the eleven DSM-IV dependence and abuse criteria, and alcohol craving. Exploratory factor, item response theory, and regression analyses were used to evaluate the psychometric properties and concurrent validity of DSM-based alcohol disorder criteria with the addition of alcohol craving.

Results

The past 12-month prevalence of craving was 1.3%. Craving formed part of a unidimensional latent variable that included existing DSM-IV criteria. Craving demonstrated high severity on the alcohol-use disorder continuum, resulting in an improved dimensional model with greater discriminatory ability compared with current DSM-IV criteria. Correlates of the diagnosis did not change with the addition of craving, and past 12-month craving was associated with prior alcohol dependence, depression, and earlier age of alcohol disorder onset among those with current DSM-IV alcohol dependence.

Conclusions

The addition of craving to the existing DSM-IV criteria yields a continuous measure that better differentiates individuals with and without alcohol problems along the alcohol-use disorder continuum. Few individuals are newly diagnosed with alcohol dependence given the addition of craving, indicating construct validity but redundancy with existing criteria.

Keywords

Alcohol cravingalcohol use disordersdiagnostic criteriaitem response theoryDSM-V
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 3 , March 2011 , pp. 629 - 640
Copyright
Copyright © Cambridge University Press 2010

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