Changes to DSM Impact Diagnoses of Alcohol-Related Disorders

The long-anticipated DSM-5 comes with some changes for diagnosing alcohol-related disorders. While the changes to the manual are carefully considered by a team of experts, many additional experts often question the impact that the changes will have on clinical practices. In the DSM-IV, alcohol disorders were separated into two distinct diagnoses. Individuals who experienced negative consequences as a result of misusing alcohol were diagnosed with alcohol abuse, while alcohol dependence was characterized by the presence of physical symptoms associated with drinking alcohol. In each of the diagnoses, one criterion was necessary to lead to a diagnosis.

In the new manual, the DSM-5, the criteria are listed for only one diagnosis related to alcohol problems. The DSM-5 lists alcohol use disorder with a continuum of severity, with two criteria required for a diagnosis. The new manual also replaces DSM-IV criteria linked to legal after-effects as a result of consuming alcohol with a new criterion linked to craving alcohol. A recent study examined how the DSM revisions would change with the new edition out this month (Agrawal, Heath & Lynsky, 2011).

To examine the impact of the changes, the researchers utilized information from 34,653 individuals who participated in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). NESARC utilized the Alcohol Use Disorders and Associated Disabilities Schedule to gather data about alcohol use disorder information related to both DSM-IV and DSM-5 criteria.

The analysis revealed that 9.7 percent of the respondents involved in NESARC met the criteria for alcohol dependence or alcohol abuse as defined by DSM-IV, but 10.8 percent met the criteria for an AUD according to DSM-5 qualifications. In addition, there were 1,033 individuals who did not meet criteria for either alcohol dependence or abuse according to the DSM-IV, but who met requirements for an AUD given the new criteria for the DSM-5. They were specified as a moderate AUD.

The analysis also showed that there were 166 respondents, or 16.1 percent who met the criterion for “craving” as noted in the DSM-5 criteria. The findings of the analysis determined that 659 individuals who met requirements for either alcohol dependence or alcohol abuse no longer qualified for any diagnosis according to the DSM-5. The authors of the study note that the findings may be limited by the use of self-report measures to gain information contained in the original data.

What the respondents reported may not reflect actual events or symptoms. The study provides evidence that there may be individuals who meet only one criteria which would place them under a diagnosis according to DSM-IV, but not under DSM-V, in which at least two criteria must be met. The findings raise concerns that there may be some individuals who may miss out on important resources to aid them in alcohol-related problems, given the two criteria requirement contained in the new DSM-5.

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