Academic journal article Alcohol Research

Classification of Alcohol Use Disorders

Academic journal article Alcohol Research

Classification of Alcohol Use Disorders

Article excerpt

Medical conditions and disorders must be carefully defined both for research and for clinical practice. The most widely used definitions for alcohol use disorders are those determined by editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association and the International Classification of Diseases (ICD) of the World Health Organization. Alcoholism treatment studies, human genetics studies, and epidemiology all rely on these definitions, which constitute a near-universal feature of research on alcoholism. Studies consistently show high reliability for DSM-IV and ICD-10 alcohol dependence but lower reliability for alcohol abuse/harmful use. Validity studies indicate that DSM-IV and ICD-10 alcohol dependence diagnoses have good validity, but the validity for alcohol abuse/harmful use is much lower. The hierarchical relationship of alcohol abuse to dependence may contribute to the reliability and validity problems of abuse, an issue likely to be addressed when work begins on DSM-V.

KEY WORDS: alcohol use disorder classification; diagnostic criteria; reliability (research methods); validity (research methods); construct validity; longitudinal study; predictive validity; factor analysis

Clear, accurate definitions of medical conditions and disorders are important for research and clinical practice. The most widely used definitions for alcohol use disorders are found in two major classification systems of disease: the Diagnostic and Statistical Manuals of Mental Disorders (DSM) of the American Psychiatric Association (APA), and the International Classification of Diseases (ICD) of the World Health Organization (WHO). Research on treatment, human genetics, and epidemiology relies on these sets of criteria to define alcohol abuse and dependence diagnoses. For example, alcoholism treatment studies often use definitions from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (APA 1994) to define inclusion criteria for subjects. Genetics studies use definitions from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) (APA 1987); the DSM-IV; or the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) (WHO 1993) to define sets of alcohol-related characteristics (i.e., phenotypes) under study. Epidemiologic research relies on DSM-IV definitions to define the alcohol use disorders enumerated in the general population and in various population subgroups. In addition, clinicians use DSM or ICD definitions as a common language in their communication about patients. DSM and ICD systems also serve an important educational function because they are used as introductory material on alcoholism for students and trainees from a variety of disciplines. As such, the concepts and definitions of DSM and ICD alcohol diagnoses form a unifying framework that underlies research and discussion of alcoholism in the United States and in other countries.

DSM-IV is the most recent edition of the DSM series and is most widely used in the United States. The previous edition, DSM-III-R, is no longer used clinically. This version remains important to researchers, however, because it was the diagnostic basis for several large and ongoing research projects, including the Collaborative Study on the Genetics of Alcoholism (COGA) (Reich et al. 1998). Outside the United States, the ICD-10 is the system more likely to be used (e.g., Conigrave et al. 2002; Lange et al. 2002; Shaikh et al. 2001; Wutzke et al. 2002). This article provides historical background on the development of the current classification systems; describes similarities and differences between DSM-III-R, DSM-IV, and ICD-10; and reviews the evidence for the reliability and validity of the alcohol dependence and abuse diagnoses.

HISTORICAL BACKGROUND

DSM-IV and ICD-10 define two alcohol use disorders-dependence and abuse. …

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