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Abstract
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OBJECTIVE: The purpose of this study was to employ the criteria for alcohol use disorder (AUD), according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), in a general population sample and to compare the diagnostic classifications and prevalence with those of DSM-IV, DSM-III-R, and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10).
METHOD: We used a stratified random sample of 1,091 participants (ages 18-64) in Stockholm County, who were interviewed between 1998 and 2002. A semistructured interview was conducted using Schedules for Clinical Assessment in Neuropsychiatry. Diagnoses were made according to DSM-5, DSM-IV, DSM-III-R, and ICD-10. Agreement was studied using Cohen's κ.
RESULTS: The prevalence of DSM-5 AUD was 11.0%, with corresponding dependence or abuse/harm diagnosis being 8.7% for DSM-IV, 8.5% for DSM-III-R, and 4.9% for ICD-10. With the shift from DSM-IV to DSM-5, 3.2% of those with no disorder were reclassified as mild AUD, whereas 28.9% of those with DSM-IV abuse were reclassified as having no disorder. The majority of the "new cases" had two DSM-IV dependence criteria, and few endorsed the new DSM-5 craving criteria. Cohen's κ between DSM-5 AUD and dependence or abuse/harm was as follows: DSM-IV,.84, DSM-III-R,.83, and ICD-10,.62. These findings were lower than the κ between the older systems: between DSM-IV and DSM-III-R,.98, between DSM-IV and ICD-10,.70, and between DSM-III-R and ICD- 10,.72.
CONCLUSIONS: In the present study population, there were more undiagnosed DSM-IV cases being diagnosed as AUD using DSM-5 than vice versa, but in total the number of cases increased moderately when going from DSM-IV to DSM-5. Concerning reliability, there are substantial to almost perfect agreements between DSM-5 classifications of AUDs and those of DSM-IV, DSM-III-R, and ICD-10.
Language: en |