Brief screens for detecting alcohol use disorder among 18-20 year old young adults in emergency departments: Comparing AUDIT-C,CRAFFT, RAPS4-QF,FAST, RUFT-Cut,and DSM-IV 2-Item Scale

Background

This study compared six of the briefest screening instruments for detecting DSM-IV-defined Alcohol Use Disorder (AUD) among older adolescents treated in Emergency Departments (ED).

Methods

The AUDIT-C, the RAPS4-QF, the FAST, the CRAFFT, the RUFT-Cut, and 2-Items from the Diagnostic and Statistical Manual IV of the American Psychiatric Association [American Psychiatric Association (1994). Diagnostic and Statistical Manual of Psychiatric Disorders, (1994) (DSM-IV). 4th ed. Washington D.C.: American Psychiatric Association] criteria for AUD (heretofore referred to as the DSM-IV 2-Item Scale) were evaluated against the criterion of a current DSM-IV diagnosis of either alcohol abuse or dependence. The instruments were administered to 181 alcohol-using older adolescents (57% males; age range 18–20 years) in an ED and compared using Receiver Operator Characteristic (ROC) analyses against the criterion of a current DSM-IV diagnosis of alcohol abuse or dependence.

Results

Of these instruments, the DSM-IV 2-Item Scale performed best for identifying AUD (88% sensitivity and 90% specificity), followed by the FAST and the AUDIT-C.

Conclusions

Two items from the DSM-IV criteria for AUD performed best for identifying ED-treated older adolescents with alcohol use disorders. The FAST and AUDIT-C performed well, but are longer and more difficult to score in the hectic environment of the Emergency Department.     

Postoperative risks associated with alcohol screening depend on documented drinking at the time of surgery

Background

Both AUDIT-C alcohol screening scores up to a year before surgery and clinical documentation of drinking over 2 drinks per day immediately prior to surgery (“documented drinking >2 d/d”) are associated with increased postoperative complications and health care utilization. The purpose of this study was to evaluate whether documented drinking >2 d/d contributed additional information about postoperative risk beyond past-year AUDIT-C screening results.

Method

Male Veterans Affairs (VA) patients who had a non-emergent, non-cardiac, major surgery assessed by the VA's Surgical Quality Improvement Program 10/2003-9/2006 and completed the AUDIT-C by mailed survey in the prior year were eligible for this study. Linear or logistic regression models compared 30-day postoperative complication(s), return to operating room (OR), hospital length of stay (LOS), and intensive care unit (ICU) days across eight groups defined by past-year AUDIT-C score and clinically documented drinking >2 d/d, with AUDIT-C scores 1–4 and no documented drinking >2 d/d as the referent, after adjusting for important covariates.

Results

Overall 8811 patients met inclusion criteria. Among patients with documented drinking >2 d/d immediately prior to surgery, postoperative risk varied widely depending on past-year AUDIT-C score; scores ≥5 were associated with increased risk of complication(s), and scores ≥9 with increased hospital LOS and ICU days. Among patients without documentation of drinking >2 d/d, increasing AUDIT-C scores were not associated with these outcomes.

Conclusions

Clinical documentation of drinking >2 d/d immediately prior to surgery contributed additional information about postoperative risk beyond past-year AUDIT-C score. However, among patients with documented drinking >2 d/d, postoperative risk varied widely depending on the AUDIT-C score.     

Are subthreshold alcohol dependence symptoms a risk factor for developing DSM-IV alcohol use disorders? A three-year prospective study of ‘diagnostic orphans’ in a national sample

Aims

Research suggests that diagnostic orphans (i.e., individuals experiencing only 1–2 criteria for DSM-IV alcohol dependence) may be at increased risk for developing more severe alcohol problems. This study aimed to: (i) investigate the course of diagnostic orphans in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), and (ii) explore whether a specific symptom endorsement pattern(s) could identify diagnostic orphans at Wave 1 who remitted or progressed to alcohol dependence at Wave 2.

Methods

Current drinkers (n = 15,751) were divided into diagnostic groups at Waves 1 and 2: no-alcohol use disorder (AUD); one-criterion orphans, two-criterion orphans, alcohol abuse, or alcohol dependence. Multinomial logistic regression analysis explored the association between diagnostic status at Wave 1 and Wave 2. Chi-square tests investigated differences in the criteria endorsement patterns of diagnostic orphans.

Results

Compared to the no-AUD group, one-criterion orphans at Wave 1 were twice as likely to be in the abuse group and four times more likely to be dependent at Wave 2. Two-criterion orphans were three times more likely to be in the abuse group and eight times more likely to have progressed to dependence. Criterion endorsement patterns of diagnostic orphans at baseline did not significantly differentiate between those who remitted and those who progressed to dependence at follow-up.

Conclusions

Like previous research, diagnostic orphans are at increased for developing to more severe alcohol problems. Relying solely on the DSM-IV AUD diagnostic criteria, however, may not be sufficient to identify those diagnostic orphans who are at risk for progressing to dependence.     

A multidimensional assessment of the validity and utility of alcohol use disorder severity as determined by item response theory models

Background

The relative severity of the 11 DSM-IV alcohol use disorder (AUD) criteria are represented by their severity threshold scores, an item response theory (IRT) model parameter inversely proportional to their prevalence. These scores can be used to create a continuous severity measure comprising the total number of criteria endorsed, each weighted by its relative severity.

Methods

This paper assesses the validity of the severity ranking of the 11 criteria and the overall severity score with respect to known AUD correlates, including alcohol consumption, psychological functioning, family history, antisociality, and early initiation of drinking, in a representative population sample of U.S. past-year drinkers (n = 26,946).

Results

The unadjusted mean values for all validating measures increased steadily with the severity threshold score, except that legal problems, the criterion with the highest score, was associated with lower values than expected. After adjusting for the total number of criteria endorsed, this direct relationship was no longer evident. The overall severity score was no more highly correlated with the validating measures than a simple count of criteria endorsed, nor did the two measures yield different risk curves. This reflects both within-criterion variation in severity and the fact that the number of criteria endorsed and their severity are so highly correlated that severity is essentially redundant.

Conclusions

Attempts to formulate a scalar measure of AUD will do as well by relying on simple counts of criteria or symptom items as by using scales weighted by IRT measures of severity.     

Smoke-free policies in drinking venues predict transitions in alcohol use disorders in a longitudinal U.S. sample

Background

Smoke-free legislation prohibiting smoking in indoor public venues, including bars and restaurants, is an effective means of reducing tobacco use and tobacco-related disease. Given the high comorbidity between heavy drinking and smoking, it is possible that the public health benefits of smoke-free policies extend to drinking behaviors. However, no prior study has examined whether tobacco legislation impacts the likelihood of alcohol use disorders (AUDs) over time. The current study addresses this gap in the literature using a large, prospective U.S. sample.

Method

Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we utilized logistic regression to examine whether the implementation of state-wide smoke-free legislation in bars and restaurants between Waves I (2001–2002) and II (2004–2005) predicted changes in DSM-IV AUD status (remission, onset, recurrence) in current drinkers at Wave I (n = 19,763) and participants who drank in public ≥once per month (n = 5913).

Results

Individuals in states that implemented smoke-free legislation in drinking venues had a higher likelihood of AUD remission compared to participants in states without such legislation. Among public drinkers, smoke-free legislation was associated with a greater likelihood of AUD remission and a lower likelihood of AUD onset. These findings were especially pronounced among smokers, men, and younger age groups.

Discussion

These results demonstrated the protective effects of smoke-free bar and restaurant policies on the likelihood of AUDs; furthermore, these findings call attention to an innovative legislative approach to decrease the morbidity and mortality associated with AUDs.     

Compatibility of current DSM-IV and proposed DSM-5 diagnostic criteria for cocaine use disorders

Objectives

The present study examined the compatibility of the current DSM-IV and proposed DSM-5 diagnostic criteria for cocaine use disorders (CUD) among state prison inmates, and evaluated the diagnostic utility of the proposed criteria in accounting for DSM-IV “diagnostic orphans” (i.e., individuals who meet one or two of the diagnostic criteria for substance dependence yet fail to report indications of substance abuse).

Method

Data were derived from routine clinical assessments of adult male inmates (N = 6871) recently admitted to the Minnesota Department of Corrections state prison system from 2000 to 2003. An automated (i.e., computer-prompted) version of the Substance Use Disorder Diagnostic Schedule-IV (SUDDS-IV; Hoffmann &; Harrison, 1995) was administered to all inmates as part of routine assessments. DSM-IV and DSM-5 criteria were coded using proposed guidelines.

Results

The past 12-month prevalence of DSM-IV CUDs was 12.7% (Abuse, 3.8%, Dependence, 8.9%), while 11.0% met past 12-month DSM-5 criteria for a CUD (Moderate [MCUD], 1.7%; Severe [SCUD], 9.3%). When DSM-5 criteria were applied, 11.8% of the DSM-IV diagnostic orphans received a MCUD diagnosis. The vast majority of those with no diagnosis (99.6%) continued to have no diagnosis, and a similar proportion who met dependence criteria (98.4%) met SCUD criteria of the proposed DSM-5. Most of the variation in diagnostic classifications was accounted for by those with a current abuse diagnosis.

Conclusions

The proposed DSM-5 criteria perform similarly to DSM-IV criteria in terms of the observed past 12-month CUD prevalence and diagnostic classifications. The proposed criteria appear to account for diagnostic orphans that may warrant a diagnosis. DSM-IV abuse cases were most affected when DSM-5 criteria were applied. Additional criteria, beyond those included in the proposed DSM-5 changes, concerning use to relieve emotional stress and preoccupation with use were frequently endorsed by those with a proposed DSM-5 diagnosis.     

Alcohol stigma and persistence of alcohol and other psychiatric disorders: A modified labeling theory approach

Background

We sought to apply modified labeling theory in a cross-sectional study of alcohol use disorder (AUD) to investigate the mechanisms through which perceived alcohol stigma (PAS) may lead to the persistence of AUD and risk of psychiatric disorder.

Methods

We conducted structural equation modeling (SEM) including moderated mediation analyses of two waves (W1 and W2) of data from the National Epidemiologic Survey on Alcohol and Related Conditions. We analyzed validated measures of PAS, perceived social support, social network involvement, and psychiatric disorders among (n = 3608) adults with two or more DSM-5 AUD symptoms in the first two of the three years between the W1 and W2 survey. Cross-sectional analyses were conducted owing to the assessment of PAS only at W2.

Results

Per mediation analyses, lower levels of perceived social support explained the association of PAS with past-year AUD and past-year internalizing psychiatric disorder at W2. The size of the mediated relationship was significantly larger for those classified as labeled (i.e., alcoholic) per their prior alcohol treatment or perceived need (n = 938) as compared to unlabeled (n = 2634), confirming a hypothesis of moderated mediation. Unexpectedly, mediation was also present for unlabeled individuals.

Conclusions

Lower levels of social support may be an important intermediate outcome of alcohol stigma. Longitudinal data are needed to establish the temporal precedence of PAS and its hypothesized intermediate and distal outcomes. Research is needed to evaluate direct measures of labeling that could replace proxy measures (e.g., prior treatment status) commonly employed in studies of the stigma of psychiatric disorders.     

Alcohol use and HIV risk taking among Chinese MSM in Beijing

Background

Few studies have used standardized alcohol use measures among men who have sex with men in China.

Methods

A cross-sectional study was conducted among MSM in Beijing. A computer-assisted self-administered questionnaire was used to collect demographics, risk behaviors the Alcohol Use Disorders Identification Test (AUDIT). AUDIT uses a cutoff score of ≥8 while AUDIT C uses a score of ≥4 to classify respondents as problem drinkers. Both include a binge drinking measure.

Results

A total of 500 participants were recruited using respondent-driven sampling. HIV and prevalence is estimated to be 6.1% (95% CI 3.7, 9.2). Almost half of MSM (42.1%, 95% CI 35.8, 49.0) never had a drink containing alcohol in the past year. 5.0% (95% CI 3.1, 7.0) and 8.8% (95% CI 6.1, 11.6) had AUDIT score ≥8 and AUDIT-C score ≥4, respectively. Binge drinking was at 11.8% (95% CI 7.9, 16.0). In multivariate models all measures were associated with alcohol during sex, while AUDIT was associated with high level of attitudes and perceptions on safe sex (AOR 0.9, 95% CI 0.9,1.0), AUDIT-C with being older (AOR 3.5, 95%CI 1.4, 8.8), and HIV status (AOR 2.2, 95% CI 1.4, 10.9), and binge drinking with number of male partners (AOR 2.0, 95% CI 1.0, 3.9) and ever having had an HIV test (AOR 1.0, 95%CI 0.9, 1.0). Compared to AUDIT ≥8, AUDIT-C ≥4 and binge drinking were more suitable in identifying HIV risks related to problem drinking.

Conclusions

Findings suggest AUDIT is appropriate for use among MSM in China and reinforces the need for incorporating problem drinking as part of approaches to prevent HIV infection among Chinese MSM.     

The reliability and validity of the Alcohol,Smoking and Substance Involvement Screening Test (ASSIST) in first-episode psychosis

Aims

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is a brief, easily administered, valid and reliable screening instrument for all psychoactive substances in drug treatment and primary care settings. This study aims to determine the reliability and validity of the ASSIST for detecting substance use disorders in first-episode psychosis.

Participants

Participants were 214 first-episode psychosis patients attending the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia.

Measurements

Participants were administered the ASSIST, Alcohol Use Disorders Identification Test (AUDIT), the Severity of Dependence Scale (SDS) and the Brief Psychiatric Rating Scale (BPRS). Presence of DSM-IV substance abuse and dependence disorders in the previous 12 months was assessed using the Structured Clinical Interview for DSM-IV (SCID-IV).

Findings

The ASSIST total substance involvement (TSI) score and specific substance involvement (SSI) scores for cannabis, alcohol and amphetamine use demonstrated high levels of internal consistency and acceptable levels of concurrent and discriminative validity. Individuals with cutoff scores of ≥ 2, 4 and 1 on the ASSIST cannabis, alcohol and amphetamine SSI scores were 5 to 6 times more likely to meet the diagnostic criteria for these substance use disorders.

Conclusions

The ASSIST is a psychometrically sound measure of cannabis, alcohol and amphetamine use disorders in first-episode psychosis.     

Sociodemographic correlates of energy drink consumption with and without alcohol: results of a community survey

Objective

We examined the sociodemographic correlates of energy drink use and the differences between those who use them with and without alcohol in a representative community sample.

Methods

A random-digit-dial landline telephone survey of adults in the Milwaukee, Wisconsin area responded to questions about energy drink and alcohol plus energy drink use.

Results

Almost one-third of respondents consumed at least one energy drink in their lifetime, while slightly over 25% used energy drinks in the past year and 6% were past-year alcohol plus energy drink users. There were important racial/ethnic differences in consumption patterns. Compared to non-users, past-year energy drink users were more likely to be non-Black minorities; and past-year alcohol plus energy drink users when compared to energy drink users only were more likely to be White and younger. Alcohol plus energy drink users also were more likely to be hazardous drinkers.

Conclusions

Our results which are among the first from a community sample suggest a bifurcated pattern of energy drink use highlighting important population consumption differences between users of energy drinks only and those who use alcohol and energy drinks together.     

Characteristics of developmentally early alcohol use disorder symptom reports: A prospective-longitudinal community study

Background

There is little prospective-epidemiological information on symptoms of DSM-IV-alcohol use disorder (alcohol abuse and dependence; AUD) that may be typical for early AUD stages or the developmental periods of adolescence and early adulthood.

Aims

To investigate AUD symptoms (AUDS) cross-sectionally at three subsequent assessment waves regarding prevalence rates, symptom counts, associated drinking patterns, positive predictive values (PPV) for DSM-IV-alcohol dependence (AD), and AUDS stability over time.

Methods

N = 2039 community subjects (baseline age 14–24 years) participated in a baseline and two follow-up assessment(s) over up to ten years. DSM-IV-AUDS, DSM-IV-AUD and craving were assessed with the DSM-IV/M-CIDI.

Results

Over the assessment waves, tolerance and much time were most and role obligations and withdrawal least frequent. Most subjects with DSM-IV-AUDS reported only one symptom (47.2–55.1%). PPV for DSM-IV-AD only exceeded 70% for activities, problem, withdrawal, and desired control; PPV were lowest for tolerance and hazardous use. For most AUDS, AUDS report compared to non-report was associated with elevated drinking frequency and amounts. Stability of baseline AUDS at four-year and ten-year follow-up did not exceed 36.4% for any symptom.

Conclusions

The overall pattern of most/least frequent AUDS reported in adolescence and early adulthood resembles findings in older adults and does not suggest a developmentally specific symptom pattern. Moderate AUDS-stability and considerable remission rates indicate that AUDS in this age group are transient for a considerable proportion of subjects. However, the associations with elevated consumption indicate that AUDS reports early in life need to be taken seriously in prevention and intervention.     

Ten-year stability and variability, drinking patterns, and impairment in community youth with diagnostic orphan status of alcohol dependence

Objective

Some adolescents and young adults who do not fulfill criteria for DSM-IV alcohol abuse (AA) report symptoms of DSM-IV alcohol dependence (AD) below the diagnostic threshold (diagnostic orphans, DOs; 1 or 2 symptoms). Contemporarily, little is known on the long-term stability, risk of progression to AD, impairment, and drinking patterns possibly associated with this status in the first decades of life.

Aim

(1) To identify prevalence rates of the DO status from adolescence to early adulthood. To investigate (2) stability and variability of the DO status over time and (3) associations between DO status, drinking patterns and impairment in comparison to subjects with AA, with AD, or without any symptoms.

Method

N = 2039 community subjects (aged 14–24 years at baseline) were assessed at baseline and at about four and ten years after baseline. DSM-IV AUD diagnoses were obtained with the DIA-X/M-CIDI.

Results

About 11–12% of the sample was classified as DOs at all waves. Over a period of ten years, 18% of DOs were stable in their diagnosis and additional 10% progressed to AD. DOs were comparable to subjects with AA in drinking patterns, impairment and stability of diagnostic status. DOs progressed to AD significantly more often than AA. AD was associated with highest levels in all outcomes of interest.

Conclusions

The DO status in adolescence and early adulthood is associated with considerable stability, risk of progression and problematic alcohol intake. In consequence, it can be meaningful for the timely identification of early stages of clinically relevant alcohol problems. For subjects with DO status early specific interventions are required.     

Optimal scaling of the CAST and of SDS Scale in a national sample of adolescents

Purpose

Psychometric and screening properties of the Cannabis Abuse Screening Test (CAST) and of the Severity Dependence Scale (SDS) were investigated using DSM-IV diagnoses of cannabis dependence (CD) as external criteria. Performance of the SDS and of the CAST were compared.

Methods

Cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) was carried out in Italy in 2009. The sample consisted of 5787 Italian adolescents aged 15–19 who reported cannabis last year use. Uni-dimensionality, internal reliability, external validity, and optimal scaling of the 6 items for CAST and 5 items for SDS were performed. The Munich Composite International Diagnostic Interview (M-CIDI) was used as a gold standard for DSM-IV diagnoses, and all outputs were assessed by 10-fold cross validation procedure.

Results

Both scales were uni-dimensional and Cronbach's α was 0.74 for SDS and 0.78 for CAST. High and comparable area under curve (AUC) values indicate a good ability of both scales to discriminate between individuals with and without dependence diagnosis. Based on balanced sensitivity and specificity, the optimal cut-off scores for problematic use disorders were 7 for CAST MCA and 4 for SDS MCA. Both CAST and SDS overestimated CD prevalence.

Conclusions

The CAST and SDS are equally useful for screening for problematic cannabis use disorders. Both clinical and research applications of the scales are possible.     

Remission from substance dependence: Differences between individuals in a general population longitudinal survey who do and do not seek help

Background

Only a minority of individuals who have substance use disorders receives treatment, and those who do typically have more severe disorders. The current study examines the relationship of help-seeking with remission from alcohol and/or drug dependence and other outcomes.

Methods

Data from the Wave 1 (2001–2002) and Wave 2 (2004–2005) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were used to examine remission at Wave 2 among respondents who had past-year substance dependence disorders at Wave 1 (N = 1262). Multi-group structural equation modeling was used to compare individuals with (n = 356) and without (n = 906) prior help-seeking at Wave 1 on subsequent help-seeking and other factors that influence outcomes.

Results

Baseline help-seekers sought help at higher levels over the follow-up period (31% vs. 8%) and had lower rates of remission (50% vs. 68%), as compared with those without prior help-seeking, respectively. Among baseline help-seekers, there were stronger relationships between baseline stress and mental disorders and having sought help since baseline; age and past-year level of stress at follow-up; level of stress and health status at follow-up; and social support and mental disorders at follow-up. Among baseline non-help-seekers, there were stronger relationships between being female and past-year stress at follow-up, and between having sought help since baseline and physical health status at follow-up.

Conclusions

Findings extend our understanding of the factors associated with recovery from substance dependence, including “natural recovery”, use of services outside of addiction treatment, and gender differences in help-seeking and remission.     

“Youthful epidemic” or diagnostic bias? Differential item functioning of DSM-IV cannabis use criteria in an Australian general population survey

Background

Prevalence rates of cannabis abuse and dependence are higher for younger adults when compared with older adults. It is necessary to examine the performance of criteria across age groups to establish whether these differences in prevalence rates are a result of diagnostic bias. The current study aims to investigate whether there is any age-related differential item functioning in the DSM-IV diagnostic criteria for cannabis use disorders using an item response theory approach.

Method

The sample consisted of 10,641 participants in a population-based survey of Australian adults aged 18 years and older. DSM-IV cannabis use disorders were assessed in all respondents who had used cannabis more than five times in the previous twelve months (n = 722). Age-based differential item functioning was assessed in each of the DSM-IV criteria for cannabis use disorders.

Results

Age-based differential item functioning was only detected in the Hazard criterion of the DSM-IV cannabis use disorders. The Hazard criterion was found to be more discriminating for those aged 18–24 when compared with those aged 25 and over.

Conclusions

The DSM-IV criteria for cannabis use disorders appear to function similarly across age groups. Differential item functioning was only detected in the α parameter for the Hazard criterion. These results are discussed with regard to implications for future editions of the DSM system.     

Childhood abuse and neglect and transitions in stages of alcohol involvement among women: A latent transition analysis approach

Background

Childhood abuse and neglect have been linked with alcohol disorders in adulthood yet less is known about the potential of early trauma to influence transitions in stages of alcohol involvement among women. Study aims were to (1) identify stages of women's alcohol involvement, (2) examine the probability of transitions between stages, and (3) investigate the influence of four domains of childhood abuse and neglect (sexual abuse, physical abuse, neglect, and witness to domestic violence), assessed individually and as poly-victimization, on transitions.

Methods

The sample consisted of 11,750 adult female current drinkers identified in Wave 1 (2001–2002) and re-interviewed in Wave 2 (2004–2005) of the National Epidemiological Survey on Alcohol and Related Conditions.

Results

Three stages of alcohol involvement emerged from latent class analysis of 11 DSM-IV abuse/dependence criteria: severe (1.5% at Wave 1, 1.9% at Wave 2), hazardous (13.6% at Wave 1, 16.0% at Wave 2), and non-problem drinking (82.1% at Wave 1, 84.5% at Wave 2). Adjusted latent transition analyses determined transition probabilities between stages across waves. Women reporting any childhood abuse and neglect were more likely to advance from the non-problem drinking class at Wave 1 to severe (AOR = 3.90, 95% CI = 1.78–8.53) and hazardous (AOR = 1.56, 95% CI = 1.22–2.01) drinking classes at Wave 2 relative to women without this history. Associations were also observed between individual domains and transition from no problems to severe alcohol stage.

Conclusions

Results suggest a long-term impact of childhood abuse and neglect as drivers of progression in women's alcohol involvement.     

Genetic influences on craving for alcohol

Introduction

Craving is being considered for inclusion in the Diagnostic and Statistical Manual (DSM) DSM-5. However, little is known of its genetic underpinnings — specifically, whether genetic influences on craving are distinct from those influencing DSM-IV alcohol dependence.

Method

Analyses were conducted in a sample of unrelated adults ascertained for alcohol dependence (N = 3976). Factor analysis was performed to examine how alcohol craving loaded with the existing DSM-IV alcohol dependence criteria. For genetic analyses, we first examined whether genes in the dopamine pathway, including dopamine receptor genes (DRD1, DRD2, DRD3, DRD4) and the dopamine transporter gene (SLC6A3), which have been implicated in neurobiological studies of craving, as well as alpha-synuclein (SNCA), which has been previously found to be associated with craving, were associated with alcohol craving in this sample. Second, in an effort to identify novel genetic variants associated with craving, we conducted a genomewide association study (GWAS). For variants that were implicated in the primary analysis of craving, we conducted additional comparisons — to determine if these variants were uniquely associated with alcohol craving as compared with alcohol dependence. We contrasted our results to those obtained for DSM-IV alcohol dependence, and also compared alcohol dependent individuals without craving to non-dependent individuals who also did not crave alcohol.

Results

Twenty-one percent of the full sample reported craving alcohol. Of those reporting craving, 97.3% met criteria for DSM-IV alcohol dependence with 48% endorsing all 7 dependence criteria. Factor analysis found a high factor loading (0.89) for alcohol craving. When examining genes in the dopamine pathway, single nucleotide polymorphisms (SNPs) in DRD3 and SNCA were associated with craving (p < 0.05). There was evidence for association of these SNPs with DSM-IV alcohol dependence (p < 0.05) but less evidence for dependence without craving (p > 0.05), suggesting that the association was due in part to craving. In the GWAS, the greatest evidence of association with craving was for a SNP in the integrin alpha D (ITGAD) gene on chromosome 7 (rs2454908; p = 1.8 × 10^− 6). The corresponding p-value for this SNP with DSM-IV alcohol dependence was similar (p = 4.0 × 10^− 5) but was far less with dependence without craving (p = 0.02), again suggesting the association was due to alcohol craving. Adjusting for dependence severity (number of endorsed criteria) attenuated p-values but did not eliminate association.

Conclusions

Craving is frequently reported by those who report multiple other alcohol dependence symptoms. We found that genes providing evidence of association with craving were also associated with alcohol dependence; however, these same SNPs were not associated with alcohol dependence in the absence of alcohol craving. These results suggest that there may be unique genetic factors affecting craving among those with alcohol dependence.     

The Benzodiazepine Dependence Questionnaire (BDEPQ): validity and reliability in Mexican psychiatric patients

Background

Benzodiazepine (BZD) dependence is a condition generally circumscribed to a therapeutic framework. Up to 44% of chronic users become dependent. The widespread use of BZD in psychiatry requires the evaluation of psychometric properties of self-reported instruments to characterize this phenomenon.

Objective

To examine the reliability, construct and criterion validity of the Benzodiazepine Dependence Questionnaire (BDEPQ) in Mexican psychiatric patients.

Method

Patients were included if they met DSM-IV criteria for any Axis I disorder and were BZD users. A total of 150 patients were recruited. Diagnoses were made with the SCID-I and BZD dependence was determined with an adaptation of the substance dependence section of the SCID-I. All patients answered the BDEPQ.

Results

Almost half of the patients met criteria for BZD dependence. The BDEPQ showed adequate factor loadings with strong alpha values for the subscales and total score. A cut-off value of 23 reached the most stable sensitivity and specificity values.

Conclusions

Psychometric properties of the BDEPQ in Mexican psychiatric patients support its utility as a tool for the clinical work and research as it shows to be a useful instrument for the early recognition of BZD dependence in clinical populations.