TY - JOUR
T1 - Algorithm Analysis of the DSM-5 Alcohol Withdrawal Symptom
AU - Martin, Christopher S.
AU - Vergés, Alvaro
AU - Langenbucher, James W.
AU - Littlefield, Andrew
AU - Chung, Tammy
AU - Clark, Duncan B.
AU - Sher, Kenneth J.
N1 - Funding Information:
This article was supported by the following: U.S. Public Health Service Grants—R01 AA021721, R01 AA13397, and K24 AA020840 (CSM); U01 AA021690 (DBC); R01 AA024133 and K05 AA017242 (KJS). The authors report no conflicts of interest related to this work.
Funding Information:
Participants were those in waves 1 and 2 of the NESARC (Grant and Kaplan, 2005; Grant et al., 2003), funded by the National Institute on Alcohol Abuse and Alcoholism and conducted by the U.S. Census Bureau. The wave 1 sample was representative of U.S. residents 18 years and older. The survey oversampled Blacks, Hispanics, and those aged 18 to 24 years. Face-to-face interviews were conducted during 2001 to 2002 with 43,093 respondents. The data set is weighted to approximate the U.S. population. For the purposes of this article, we analyzed data from 26,946 past-12-month (i.e., “current”) alcohol users from wave 1. This sample had a mean age of 42.7 years (SD = 16.13), 47.4% female, 75.3% White/non-Hispanic, 9.0% African American, 10.6% Hispanic, 3.2% Asian, and 1.9% American Indian. All participants from wave 1 were recruited to participate in a wave 2 assessment 3 years later, when they were age 21 years and older. The primary sample from wave 2 used here for predictive validity analyses (n = 22,245; 83.4% of wave 1 current drinkers) had a similar ethnic composition, a mean age of 45.9 years (SD = 16.12), and 47.5% female. We also calculated the prevalence of AW and DSM-5 AUD among wave 2 current drinkers (n = 22,177).
Publisher Copyright:
Copyright © 2018 by the Research Society on Alcoholism
PY - 2018/6
Y1 - 2018/6
N2 - Background: Alcohol withdrawal (AW) is an important clinical and diagnostic feature of alcohol dependence. AW has been found to predict a worsened course of illness in clinical samples, but in some community studies, AW endorsement rates are strikingly high, suggesting false-positive symptom assignments. Little research has examined the validity of the DSM-5 algorithm for AW, which requires either the presence of at least 2 of 8 subcriteria (i.e., autonomic hyperactivity, tremulousness, insomnia, nausea, hallucinations, psychomotor agitation, anxiety, and grand mal seizures), or, the use of alcohol to avoid or relieve these symptoms. Methods: We used item and algorithm analyses of data from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (current drinkers, n = 26,946 at wave 1) to study the validity of DSM-5 AW as operationalized by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV (AUDADIS-IV). Results: A substantial proportion of individuals given the AW symptom reported only modest to moderate levels of alcohol use and alcohol problems. Alternative AW algorithms were superior to DSM-5 in terms of levels of alcohol use and alcohol problem severity among those with AW, group difference effect sizes, and predictive validity at a 3-year follow-up. The superior alternative algorithms included those that excluded the nausea subcriterion; required withdrawal-related distress or impairment; increased the AW subcriteria threshold from 2 to 3 items; and required tremulousness for AW symptom assignment. Conclusions: The results indicate that the DSM-5 definition of AW, as assessed by the AUDADIS-IV, has low specificity. This shortcoming can be addressed by making the algorithm for symptom assignment more stringent.
AB - Background: Alcohol withdrawal (AW) is an important clinical and diagnostic feature of alcohol dependence. AW has been found to predict a worsened course of illness in clinical samples, but in some community studies, AW endorsement rates are strikingly high, suggesting false-positive symptom assignments. Little research has examined the validity of the DSM-5 algorithm for AW, which requires either the presence of at least 2 of 8 subcriteria (i.e., autonomic hyperactivity, tremulousness, insomnia, nausea, hallucinations, psychomotor agitation, anxiety, and grand mal seizures), or, the use of alcohol to avoid or relieve these symptoms. Methods: We used item and algorithm analyses of data from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (current drinkers, n = 26,946 at wave 1) to study the validity of DSM-5 AW as operationalized by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV (AUDADIS-IV). Results: A substantial proportion of individuals given the AW symptom reported only modest to moderate levels of alcohol use and alcohol problems. Alternative AW algorithms were superior to DSM-5 in terms of levels of alcohol use and alcohol problem severity among those with AW, group difference effect sizes, and predictive validity at a 3-year follow-up. The superior alternative algorithms included those that excluded the nausea subcriterion; required withdrawal-related distress or impairment; increased the AW subcriteria threshold from 2 to 3 items; and required tremulousness for AW symptom assignment. Conclusions: The results indicate that the DSM-5 definition of AW, as assessed by the AUDADIS-IV, has low specificity. This shortcoming can be addressed by making the algorithm for symptom assignment more stringent.
KW - Alcohol Dependence
KW - Alcohol Use Disorders
KW - Alcohol Use Disorders and Associated Disabilities Interview Schedule
KW - Diagnostic Assessment
KW - Withdrawal
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U2 - 10.1111/acer.13633
DO - 10.1111/acer.13633
M3 - Article
C2 - 29570805
AN - SCOPUS:85045232911
SN - 0145-6008
VL - 42
SP - 1073
EP - 1083
JO - Alcoholism: Clinical and Experimental Research
JF - Alcoholism: Clinical and Experimental Research
IS - 6
ER -