Characteristics of DSM-IV alcohol diagnostic orphans: drinking patterns, physical illness, and negative life events

BackgroundInterest in subthreshold psychiatric disorders has increased recently. Diagnostic orphans experience one to two criteria of alcohol dependence but do not meet the diagnostic criteria for a DSM-IV alcohol use disorder (AUD). This study investigated the impact of subthreshold alcohol symptoms on three domains: physical illness, drinking patterns, and the occurrence of negative life events.MethodCurrent drinkers (n = 26,946) in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were divided into five diagnosis groups: no-AUD; one-criterion orphans (reference group), two-criterion orphans, alcohol abuse, and alcohol dependence. Exploratory factor analysis examined the factor structure of items in the Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS-IV) relating to each life domains. Factors were related to the diagnosis groups and background covariates using latent variable modeling.ResultsOne-criterion orphans did not differ from the other groups with regards to physical illness. One- and two-criterion orphans differed significantly in relation to drinking patterns, with the latter group engaging in hazardous drinking behaviours more frequently. The dependence group were more likely to experience higher estimates of social problems compared to one-criterion orphans. One-criterion orphans were more likely than the abuse group to experience financial problems but less likely than the dependence group to experience family-related legal problems.ConclusionsDiagnostic orphans were more impaired than those with no-AUD or alcohol abuse in specific life domains; however, diagnostic orphans were significantly less impaired than those with alcohol dependence. Diagnostic orphans may be an important group for early case identification and intervention.     

'Diagnostic orphans' among young adult cannabis users: persons who report dependence symptoms but do not meet diagnostic criteria

OBJECTIVE: To examine the characteristics of 'diagnostic orphans' among cannabis users-those who report one or two symptoms of DSM-IV dependence but do not meet diagnostic criteria for DSM-IV abuse or dependence. METHOD: Data were collected from a representative population cohort of 1601 young adults aged 20-21 years. Those who reported that they had used cannabis at least weekly at some point within the past year were assessed for symptoms of DSM-IV cannabis abuse and dependence using the Composite International Diagnostic Interview. RESULTS: Approximately 2.8% of the cohort could be classified as diagnostic orphans, with another 3.0 and 7.5% meeting criteria for abuse and dependence, respectively. Diagnostic orphans were: similar to those who met criteria for cannabis abuse or dependence in terms of demographic characteristics; similar to those who met criteria for cannabis abuse in terms of cannabis use patterns; and similar to those who met criteria for abuse and dependence in their rates of heavy alcohol use and DSM-IV alcohol dependence. However, they did not appear to have elevated rates of illicit drug use or mental health problems compared to non users. CONCLUSIONS: Diagnostic orphans reported using cannabis in a manner similar to persons meeting criteria for cannabis abuse, and had similar rates of alcohol dependence and other illicit drug use. Strict adherence to DSM-IV diagnoses of abuse and dependence may overlook a substantial proportion of young persons who experience cannabis-related problems. There is a need to consider (a) subthreshold levels of cannabis-related problems among those seeking treatment for other problems; and (b) interventions for this group to prevent escalation of such problems.     

Diagnostic orphans: comparing self-report lifetime course to groups with DSM-IV alcohol abuse and dependence

Research has highlighted the significant alcohol symptoms and mental health problems experienced by diagnostic orphans - individuals who experience 1-2 criteria of DSM-IV alcohol dependence but do not meet the criteria for a DSM-IV alcohol use disorder. This study used a sub-sample (n=34827) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), and formed mutually exclusive groups to compare the self-report retrospective course of diagnostic orphans to individuals with DSM-IV abuse and dependence. Multinomial logistic regressions were conducted to examine the associations between the groups and a range of demographic and clinical variables. Collectively, the findings demonstrate that diagnostic orphans shared similar characteristics to the abuse and dependence groups, but appeared to experience specific comorbid mental health problems. Orphan status has the potential to be a persistent condition and may result in significant dysfunction. In conclusion, diagnostic orphans represent a distinct group that may benefit from cost-effective treatment or intervention, designed to prevent the escalation of alcohol symptoms.     

Are diagnostic orphans at risk of developing cannabis abuse or dependence? Four-year follow-up of young adult cannabis users not meeting diagnostic criteria

OBJECTIVE: To examine the characteristics of "diagnostic orphans" among cannabis users - those who report one or two symptoms of DSM-IV dependence but do not meet diagnostic criteria for DSM-IV abuse or dependence - 4 years post-assessment. METHOD: Data were collected from a representative population cohort of young Australian adults. Those who reported that they had used cannabis at least weekly at some point within the past year were assessed for symptoms of DSM-IV cannabis abuse and dependence using the Composite International Diagnostic Interview at age 20-21 years. The entire sample was followed up 4 years later. At age 24-25 years, cannabis use and cannabis diagnostic category were examined according to diagnostic category at age 20-21 years. RESULTS: Diagnostic orphans at age 20-21 years were more likely than non-problem cannabis users at that age to be using cannabis, and to meet criteria for cannabis abuse or dependence 4 years later. Those who had met criteria for cannabis abuse or dependence, however, appeared to be at greater risk relative to non-problematic users and diagnostic orphans of meeting criteria for cannabis abuse and dependence at follow-up. CONCLUSIONS: Young adult diagnostic orphans for cannabis use appear to be at lower risk of meeting full (or partial) diagnostic criteria after a 4-year follow-up, compared to those who had met criteria for cannabis abuse or dependence. This suggests that there is prognostic diagnostic utility in the threshold for dependence symptoms among young adult cannabis users. Diagnostic orphans did appear to be at greater risk than non-problem users for developing dependent and daily cannabis use, however, suggesting that clinicians would do well to intervene with this group.     

A five-year prospective study of diagnostic orphans for alcohol use disorders

OBJECTIVE: One consequence of the DSM-IV diagnostic system for substance abuse and dependence is that there are individuals who might endorse one or two of the criterion items for dependence but not meet criteria for abuse. These persons have been referred to as "diagnostic orphans." The aim of the analyses presented here is to further understanding about this potentially important group. METHOD: The DSM-IV categorical approach was used to determine alcohol-related diagnoses for 439 young adult men. Structured face-to-face follow-up interviews were administered 5 years later. RESULTS: At the beginning of the evaluation period, 14.6% (n = 64) of the men were alcohol dependent, 18.2% (n = 80) fulfilled criteria for alcohol abuse, 16.4% (n = 72) did not meet criteria for an alcohol use disorder but endorsed one or two of the dependence criteria and 50.8% (n = 223) reported none of the dependence items. At the initial interview, and again 5 years later, the diagnostic orphans reported alcohol and drug use histories that fell between the histories of those with dependence and those with no alcohol-related difficulties. The orphans were most similar to the men with abuse, although they had lower quantities and frequencies of alcohol use, endorsed fewer additional alcohol-related problems and reported less involvement with drugs compared with that group. CONCLUSIONS: Although the diagnostic orphans were more similar to the subjects with alcohol abuse than they were to those with dependence or no diagnosis, the data do not necessarily support combining the orphans with those with abuse. These diagnostic orphans do, however, constitute an important group that carries an enhanced risk for alcohol use disorders and should be closely followed.     

Diagnosing alcohol abuse in alcohol dependent individuals: Diagnostic and clinical implications

In DMS-IV, the diagnosis of alcohol abuse is precluded by the diagnosis of alcohol dependence. The goal of this study was to examine the diagnostic and clinical implications of diagnosing alcohol abuse among alcohol dependent individuals. Treatment-seeking psychiatric outpatients with a lifetime history of alcohol dependence (n = 544), some of whom (n = 45) did not meet lifetime criteria for alcohol abuse completed in-depth, face-to-face, semi-structured clinical assessments of DSM-IV axis I and axis II psychopathology. Alcohol dependent patients who did not meet criteria for alcohol abuse were significantly more likely to be female, have a later age of onset for alcohol dependence, have fewer dependence symptoms, and have a lower rate of positive family history for alcoholism, and were less likely to report a lifetime history of DSM-IV drug use disorders and PTSD. These findings suggest that diagnosing alcohol abuse among alcohol dependent patients may be clinically useful as an index of severity and higher likelihood of comorbid drug abuse and dependence. Future studies are needed to establish whether these differences are clinically significant in terms of the course of the disorder and response to treatment.     

Using cluster analysis of alcohol use disorders to investigate 'diagnostic orphans': subjects with alcohol dependence symptoms but no diagnosis

The purpose of this paper is to examine the characteristics of community subjects with one or two alcohol dependence symptoms who did not satisfy the criteria for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) alcohol dependence or abuse (sub-diagnostic group or diagnostic orphans). Variables not included in the DSM-IV alcohol abuse and dependence criteria are used to compare the different alcohol statuses. The results indicate that the sub-diagnostic group ‘diagnostic orphans’ formed a cluster distinct from that of the non-problem drinkers group, and appeared to be closer to those with alcohol abuse than to those with alcohol dependence. The diagnosis of DSM-IV alcohol dependence (with three, four, or five or more symptoms) appeared to be its own entity. The findings lend credence to the requirement of three symptoms (in any 12 months) for the diagnosis of alcohol dependence in DSM-IV. However, those with one or two symptoms of alcohol dependence should be considered along with alcohol abuse as an entity in future DSM classifications.     

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.     

Prevalence of DSM-IV and DSM-5 alcohol,cocaine, opioid,and cannabis use disorders in a largely substance dependent sample

BackgroundThe fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will soon replace the DSM-IV, which has existed for nearly two decades. The changes in diagnostic criteria have important implications for research and for the clinical care of individuals with Substance Use Disorders (SUDs).MethodsWe used the Semi-Structured Assessment for Drug Dependence and Alcoholism to evaluate the lifetime presence of DSM-IV abuse and dependence diagnoses and DSM-5 mild, moderate, or severe SUDs for alcohol, cocaine, opioids, and cannabis in a sample of 7,543 individuals recruited to participate in genetic studies of substance dependence.ResultsSwitches between diagnostic systems consistently resulted in a modestly greater prevalence for DSM-5 SUDs, based largely on the assignment of DSM-5 diagnoses to DSM-IV “diagnostic orphans” (i.e., individuals meeting one or two criteria for dependence and none for abuse, and thus not receiving a DSM-IV SUD diagnosis). The vast majority of these diagnostic switches were attributable to the requirement that only two of 11 criteria be met for a DSM-5 SUD diagnosis. We found evidence to support the omission from DSM-5 of the legal criterion due to its limited diagnostic utility. The addition of craving as a criterion in DSM-5 did not substantially affect the likelihood of an SUD diagnosis.ConclusionThe greatest advantage of DSM-5 for the diagnosis of SUDs appears to be its ability to capture diagnostic orphans. In this sample, changes reflected in DSM-5 had a minimal impact on the prevalence of SUD diagnoses.     

Measures of Substance Consumption Among Substance Users, DSM-IV Abusers, and Those With DSM-IV Dependence Disorders in a Nationally Representative Sample

ABSTRACT. Objective: Neither the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), nor the DSM-IV uses measures of substance consumption as part of the diagnostic criteria for substance use disorders. Therefore, this report examined the extent to which frequency and/or quantity of consumption across a broad spectrum of substances are associated with DSM-IV diagnoses of specific substance use disorders and whether there are informative hierarchical levels of consumption among users, abusers, and those who are substance dependent in the U.S. general population. Method: The analyses focused on consumption data from respondents of the 2001-2002 National Epidemiologic Survey of Alcohol and Related Disorders. Multinomial logistic regression was used to predict DSM-IV diagnoses of dependence or abuse based on the continuous consumption measures. Results: Among individuals who used substances, the substances with the greatest liability for dependence were nicotine first and cocaine second. For nearly all substances investigated, users without specific substance use disorders demonstrated lower levels of quantity and frequency of consumption relative to those with DSM-IV abuse and dependence disorders. Dose-response curves for the log odds of abuse and dependence suggested unidimensionality of abuse and dependence for frequency of alcohol drinking; frequency of cannabis use; frequency of opioid use; frequency of hallucinogen use; and, to a lesser extent, frequency of amphetamine use. However, the dose-response curves for the quantity of alcohol consumed demonstrated differential patterns for abuse and dependence such that alcohol dependence has a distinctly greater "quantity of use" relationship than that found among alcohol-abusing individuals. Conclusions: These results confirm the findings of others concerning the unidimensionality of abuse and dependence diagnoses when consumption variables alone are examined and suggest that consumption measures may be useful metrics gauging severity. (J. Stud. Alcohol Drugs, 73, 820-828, 2012).     

Construct validity for alcohol dependence as indicated by the SUDDS-IV

OBJECTIVE: This study considers the diagnostic construct validity of the DSM-IV (Diagnostic and Statistical Manual-lV) for "alcohol dependence". Previous reports have indicated that "dependence" constitutes a more distinct and pronounced syndrome than "alcohol abuse". METHOD: Data were collected in 2000-2001 on 1340 male and female inmates evaluated for "substance use disorders" using the SUDDS-IV, a detailed structured diagnostic interview, to collect data on all of the DSM-IV diagnostic criteria for "abuse" and "dependence". RESULTS: Dependent individuals tended to produce distinct and extensive symptom profiles that distinguished them from individuals without a diagnosis or those meeting abuse criteria. CONCLUSIONS: Alcohol dependence as defined by the DSM-IV appears to be quite distinct from abuse and can be identified unequivocally for the majority of dependent cases.     

Construct Validity for Alcohol Dependence as Indicated by the SUDDS-IV

Objective.?This study considers the diagnostic construct validity of the DSM-IV (Diagnostic and Statistical Manual-IV) for “alcohol dependence”. Previous reports have indicated that “dependence” constitutes a more distinct and pronounced syndrome than “alcohol abuse”. Method.?Data were collected in 2000–2001 on 1340 male and female inmates evaluated for “substance use disorders” using the SUDDS-IV, a detailed structured diagnostic interview, to collect data on all of the DSM-IV diagnostic criteria for “abuse” and “dependence”. Results.?Dependent individuals tended to produce distinct and extensive symptom profiles that distinguished them from individuals without a diagnosis or those meeting abuse criteria. Conclusions.?Alcohol dependence as defined by the DSM-IV appears to be quite distinct from abuse and can be identified unequivocally for the majority of dependent cases.     

Tri-city study of Ecstasy use problems: a latent class analysis

This study used latent class analysis to examine distinctive subtypes of Ecstasy users based on 24 abuse and dependence symptoms underlying standard DSM-IV criteria. Data came from a three site, population-based, epidemiological study to examine diagnostic nosology for Ecstasy use. Subject inclusion criteria included lifetime Ecstasy use exceeding five times and once in the past year, with participants ranging in age between 16 and 47 years of age from St. Louis, Miami, U.S. and Sydney, Australia. A satisfactory model typified four latent classes representing clearly differentiated diagnostic clusters including: (1) a group of sub-threshold users endorsing few abuse and dependence symptoms (negatives), (2) a group of 'diagnostic orphans' who had characteristic features of dependence for a select group of symptoms (mild dependent), (3) a 'transitional group' mimicking the orphans with regard to their profile of dependence also but reporting some abuse symptoms (moderate dependent), and (4) a 'severe dependent' group with a distinct profile of abuse and dependence symptoms. A multinomial logistic regression model indicated that certain latent classes showed unique associations with external non-diagnostic markers. Controlling for demographic characteristics and lifetime quantity of Ecstasy pill use, criminal behavior and motivational cues for Ecstasy use were the most efficient predictors of cluster membership. This study reinforces the heuristic utility of DSM-IV criteria applied to Ecstasy but with a different collage of symptoms that produced four distinct classes of Ecstasy users.     

Diagnosis and assessment of alcohol use disorders among adolescents

The diagnostic criteria for alcohol use disorders (AUDs) (i.e., alcohol abuse and alcohol dependence) as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were developed largely from research and clinical experience with adults. Little is known about the validity of these criteria when applied to adolescents. Recent epidemiological and clinical studies of AUDs and their symptoms among adolescents have indicated that the DSM-IV criteria have significant limitations when applied to this age group. Diagnostic interviews and screening tools for adolescent AUDs are discussed. Numerous instruments are available that have shown moderate-to-high reliability and validity in assessing AUDs among adolescents.     

Drinking patterns among individuals with and without DSM-IV alcohol use disorders

OBJECTIVE: The purpose of this study was to compare alcohol consumption patterns among individuals with and without alcohol use disorders, using a representative sample of the general population that would not exaggerate differences as a result of selection biases associated with treatment for alcohol problems. METHOD: Based on data from 18,352 past-year drinkers selected from a nationally representative sample of U.S. households, 11 measures of past-year alcohol consumption were compared for three diagnostic groups: (1) individuals who did not meet the criteria for either alcohol abuse or dependence, i.e., those without a DSM-IV alcohol use disorder (AUD); (2) those classified with abuse only; and (3) those classified with alcohol dependence, with or without abuse. RESULTS: For all measures reflecting frequency and quantity of drinking, frequency of heavy drinking and intoxication, and frequency of atypical temporal drinking patterns, the values for abusers lay midway between those for individuals without an AUD and those with dependence. Individuals with alcohol use disorders drank a greater proportion of their ethanol intake in the form of beer and a lower proportion in the form of wine than did those without an AUD. Of all the consumption measures considered, frequency of intoxication showed the strongest association with the probability of having an AUD, followed by frequency of drinking 5 + drinks, prevalence of morning drinking and total volume of intake. The ratios of consumption measures for individuals with disorders relative to those without an AUD showed relatively little significant variation across demographic subgroups of the population. CONCLUSIONS: The findings supported the distinction between the disorders of alcohol abuse and dependence, and implicated loss of control as an important element of this distinction. They also indicated that even among individuals with alcohol use disorders, demographic differentials reflecting cultural, physiological and normative forces were maintained and should be considered in approaches to treatment.     

Test-retest reliability of the alcohol and drug use disorder sections of the schedules for clinical assessment in neuropsychiatry (SCAN)

This report presents the results of a test-retest reliability study of the alcohol and drug dependence, as well as harmful use/abuse were investigated in Ankara, Turkey and Farmington, Connecticut (US). Reliabilities for the past year, prior to past year, and lifetime diagnosis of alcohol and drug use disorders were evaluated using ICD-IO, DSM-III-R and DSM-IV criteria. The results indicate that SCAN alcohol and drug diagnosis have good to excellent levels of reliability for dependence across different substances, different diagnostic systems, and different cultural groups. Diagnostic classification of alcohol and drug abuse/harmful use was considerably less reliable. Implications of the findings are discussed.     

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.     

Diagnostic concordance of DSM-III, DSM-III-R, DSM-IV and ICD-10 alcohol diagnoses in adolescents

OBJECTIVE: Little is known about the validity of diagnostic criteria for alcohol use disorders (AUDs) when applied to adolescents. This study examined the diagnostic concordance of DSM-III, DSM-III-R, DSM-IV and ICD-10 AUDs in a sample of adolescents with a broad range of alcohol problem severity. METHOD: Participants were 413 adolescents (250 male), ages 13 to 19, drawn from clinical and community sources. AUDs were assessed using the Structured Clinical Interview for the DSM (SCID), modified to make diagnoses in the four nosological systems. Diagnostic agreement for lifetime diagnoses was quantified with the kappa statistic. RESULTS: Agreement was fair to high across the three categories of alcohol dependence, alcohol abuse and no alcohol diagnosis (kappa = 0.51 to 0.76); for alcohol dependence (kappa = 0.51 to 0.83); and for the categories of any AUD versus no AUD (kappa = 0.55 to 0.96). Concordance was very low for alcohol abuse diagnoses (kappa = 0.10 to 0.23), with the exception of DSM-III-R and DSM-IV (kappa = 0.62). Dependence was superior to abuse in the degree of temporal overlap in diagnostic agreements. CONCLUSIONS: Similar to findings with adults, diagnostic concordance among adolescents tended to be fair to high for alcohol dependence and very low for alcohol abuse. The data highlight the inconsistency across nosological systems in the conceptual framework and definition of the alcohol abuse category.     

Alcohol abuse and dependence among U.S. college students

OBJECTIVE: To estimate the prevalence of alcohol abuse and dependence among U.S. college students, and to identify characteristics associated with these diagnoses. METHOD: More than 14,000 students at 119 4-year U.S. colleges completed a questionnaire that included items corresponding to DSM-IV diagnostic criteria for alcohol abuse and dependence. Frequencies were computed, and correlations used to identify demographic, drinking and other variables associated with these diagnoses. RESULTS: 31% percent of students endorsed criteria for an alcohol abuse diagnosis and 6% for a dependence diagnosis in the past 12 months. More than two of every five students reported at least one symptom of abuse or dependence. Students who were heavy episodic drinkers were more likely than those who were not to have an alcohol disorder. Students who were frequent heavy episodic drinkers had 13 times greater odds for abuse and 19 times greater odds for dependence. One of every five heavy episodic drinkers was classified with dependence. Few reported seeking treatment since coming to college. Students from heavy drinking college environments were more likely to have abuse and dependence diagnoses. CONCLUSIONS: Many college students report behaviors and symptoms that meet the diagnostic standard for alcohol abuse or dependence. In addition to strengthening prevention programs, colleges should implement new strategies for screening and early identification of high risk student drinkers and ensure that treatment is readily available for those with alcohol disorders.     

Reliability of substance use disorder diagnoses among African-Americans and Caucasians

Cross cultural research on substance use disorders (SUD) demands diagnostic measures and criteria that apply equally well to persons of different ethnic backgrounds. To evaluate the reliability of SUD in different ethnic groups, comparisons were made of the one week test/retest agreement on DSM-IV lifetime dependence disorders for 196 African-American (AA) and 107 Caucasian (C) respondents using the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). Overall we found excellent reliability, using kappa (k) statistics, in diagnosing both AA and C respondents with alcohol dependence (AA k = 0.78; C k = 0.80) and opiate dependence (AA k = 0.77; C k = 0.71), good reliability for diagnosing both AA respondents (k = 0.63) and C respondents with cocaine dependence (k = 0.67), and to good reliability for both AA and C respondents with cannabis dependence (AA k = 0.50; C k = 0.69). Reliability of the dependence/abuse criteria was consistent with the overall diagnostic reliability but some variation was noted. No significant differences in the kappas were found between the two ethnic groups for any of the substance dependence diagnoses, and only one dependence or abuse criterion (continued use of cocaine despite physical/psychological problems) differed significantly between AA and C respondents. These initial results indicate that DSM-IV dependence diagnoses as measured by the CIDI-SAM apply equally well to AA and C respondents.