Threshold and optimal cut-points for alcohol use disorders among patients in the emergency department

Background: Current research suggests that Diagnostic and Statistical Manual of Mental Disorder (DSM)‐IV alcohol abuse and dependence form a unidimensional continuum in emergency department (ED) patients in 4 countries: Argentina, Mexico, Poland, and the United States. In this continuum of alcohol use disorder (AUD), there are no clear‐cut distinctions between the criteria for dependence and abuse in the severity dimension based on prior results from item response theory (IRT) analysis. Nevertheless, it is desirable to find a threshold for identifying cases for clinical practice and cut‐points of clinical utility in this continuum to distinguish between patients more or less affected by an AUD, using a scale of symptoms count. Methods: Data from 5,193 patients in 7 ED sites in the same 4 countries (3,191 current drinkers) were used to study the structure, threshold, and possible cut‐points for the diagnoses of AUD. Results: The proposed changes in the DSM‐V, dropping the abuse item “legal problems” and adding an item on “craving,” did not impact the IRT performance and unidimensionality of AUD in this sample. With a total set of 11 items (deleting “legal problems” and adding “craving” to the current set of DSM criteria), an endorsement of 2 or more criteria can be used as the threshold to define those with an AUD in clinical practice. Furthermore, we can distinguish at least 2 levels of clinical severity, 2 to 3 criteria (moderate), and 4 or more criteria (severe). Conclusions: A dimensional approach to AUD using the proposed new set of criteria for the DSM‐V can be used to propose a threshold and levels of severity. More research in different populations and countries is needed to further substantiate a threshold and cut‐points that could be used in new formulations of substance use disorders.     

The dimensionality of alcohol use disorders and alcohol consumption in a cross‐national perspective

Aims To replicate the finding that there is a single dimension trait in alcohol use disorders and to test whether the usual 5+ drinks for men and 4+ drinks for women and other measures of alcohol consumption help to improve alcohol use disorder criteria in a series of diverse patients from emergency departments (EDs) in four countries. Design Cross‐sectional surveys of patients aged 18 years and older that reflected consecutive arrival at the ED. The Composite International Diagnostic Interview Core was used to obtain a diagnosis of DSM‐IV alcohol dependence and alcohol abuse; quantity and frequency of drinking and drunkenness as well as usual number of drinks consumed during the last year. Setting Participants were 5195 injured and non‐injured patients attending seven EDs in four countries: Argentina, Mexico, Poland and the United States (between 1995–2001). Findings Using exploratory factor analyses alcohol use disorders can be described as a single, unidimensional continuum without any clear‐cut distinction between the criteria for dependence and abuse in all sites. Results from item response theory analyses showed that the current DSM‐IV criteria tap people in the middle–upper end of the alcohol use disorder continuum. Alcohol consumption (amount and frequency of use) can be used in all EDs with the current DSM‐IV diagnostic criteria to help tap the middle–lower part of this continuum. Even though some specific diagnostic criteria and some alcohol consumption variables showed differential item function across sites, test response curves were invariant for ED sites and their inclusion would not impact the final (total) performance of the diagnostic system. Conclusions DSM‐IV abuse and dependence form a unidimensional continuum in ED patients regardless of country of survey. Alcohol consumption variables, if added, would help to tap patients with more moderate severity. The DSM diagnostic system for alcohol use disorders showed invariance and performed extremely well in these samples.     

Cohort effects on gender differences in alcohol dependence

Aims The present study investigated the presence of cohort effects on gender differences in the course, severity and symptomatology of DSM‐III‐R alcohol dependence in a community‐based sample. Design A comparison of substance‐related variables among men and women divided into two groups based on the median birth year of the sample was conducted. Participants Participants were 468 men and 132 women with life‐time alcohol dependence, the vast majority of whom were born between 1941 and 1960. Measurements Substance use and DSM‐III‐R substance use disorders were assessed by a structured interview administered in person. Findings Individuals born after 1951 had higher rates of alcohol dependence. Among individuals with alcohol dependence, those born after 1951 had an earlier onset and longer duration of alcohol‐related problems. Significant interactions indicated that these effects were stronger for women than men. Conclusions Risk for alcohol dependence appears to be rising in younger generations, and particularly for younger women, making them an important target group for prevention and treatment programs.     

Risk of alcohol abuse in urban versus rural DUI offenders

Background: Research concerning driving under the influence (DUI) offenses in rural populations is scarce and has often been carried out in the context of substance abuse and illicit drug use. Although previous studies have suggested that rural individuals are more likely to abstain from alcohol use, recent trends suggest that alcohol and substance abuse problems in rural areas are occurring at rates similar to urban areas. It is possible that urban and rural DUI offenders may differ on psychological and behavioral characteristics associated with heavy alcohol consumption. Objective: The aim of this study was to examine alcohol use differences between urban and rural DUI offenders. Methods: Data from 11?066 DUI offenders in a Midwestern state were used for this study. The Alcohol subscale of the Driver Risk Inventory II was used to assess the risk of problem alcohol use. Results: Higher levels of alcohol risk were associated with rural DUI offenders after adjusting for several demographic variables and blood-alcohol content level at time of arrest [Medium Risk OR?=?1.43, 95% CI: (1.20, 1.71); Problem Risk OR?=?1.43, 95% CI: (1.19, 1.72); Severe Risk OR?=?1.38, 95% CI: (1.14, 1.67)]. Conclusions: The results of this study indicate that rural DUI offenders have a significantly greater risk of heavy alcohol use when compared to urban DUI offenders. Practical implications of these results suggest that evaluators and assessors should be aware of an increased likelihood of alcohol problems in rural DUI individuals relative to those in urban areas.     

Substance Abuse Problem Severity Among Rural and Urban Female DUI Offenders

Objectives: Although there has been an overall decline in the rates of driving under the influence (DUI) over the past two decades, this decrease has not occurred uniformly across all groups of DUI offenders. For example, the proportion of female DUI offenders has significantly increased. Furthermore, DUI arrest rates remain higher in less populated areas of the country. The present study examines indicators of problem severity among female DUI offenders across graduated levels of rurality. Methods: A total of 19,094 substance abuse assessment records from females convicted of DUI between 2002 and 2006 in Kentucky were examined. Beale codes were used to define the extent to which the county of conviction was rural. Results: Rurality was significantly and positively associated with multiple DUI offenses, being underage, drug problems, prevalence of DSM-IV-TR substance dependence and abuse criteria, being referred to substance abuse treatment rather than an education only intervention, and referral noncompliance. Blood alcohol concentration and alcohol problems were inversely related to rurality. Conclusion: The study suggests that problem severity among female DUI offenders may be greater in rural areas and could produce challenges for practitioners who assess and treat rural female DUI offenders.     

Alcohol dependence: a public health perspective

Aims To review epidemiological research on alcohol dependence and to propose a public health approach to address this problem. Design and setting The research under review is basically constituted by general population surveys. Participants Individuals in the community 18 years of age and older. Measurement Twelve‐month rates of alcohol dependence are estimated using DSM criteria. Findings The prevalence of alcohol dependence has been stable in the United States, at around 6% for men and 2% for women. The risk of alcohol dependence begins at low levels of drinking and increases linearly with alcohol consumption. Mean group level of consumption shows some relationship to prevalence of dependence. Alcohol‐dependent individuals are responsible for about 50% of the social, legal and interpersonal alcohol‐related problems in society. Conclusion Alcohol dependence is present at relatively high levels in the community. Alcohol‐dependent individuals are responsible for a fair proportion of alcohol‐related problems in society. A public health approach to this problem, emphasizing prevention and group level interventions to lower prevalence levels, is warranted.     

Item response theory analysis of binge drinking and its relationship to lifetime alcohol use disorder symptom severity in an American Indian community sample

Background: Item response theory (IRT) has been used to examine alcohol use disorder (AUD) symptoms and their psychometric properties but has not been previously applied to AUD symptoms from an American Indian sample. Methods: Lifetime DSM‐IV AUD symptoms and binge drinking (5+ drinks men/4+ drinks women) at ≥1, ≥4, ≥8, and ≥15 days per month during the period of heaviest lifetime drinking criteria were assessed in 530 American Indian participants. Exploratory factor analysis was used to examine the factor structure of the 10 AUD symptoms and each alcohol consumption criterion. Two‐parameter IRT models generated marginal maximum likelihood estimates for discrimination (a) and threshold (b) parameters for 10 DSM‐IV AUD symptoms and each consumption criterion. Differential item functioning (DIF) analysis was used to assess AUD symptom severity in groups defined by gender and age at interview. Results: The AUD symptoms of “Withdrawal” and “Activities Given Up” were the most severe symptoms. “Tolerance” and “Social/Interpersonal Problems” were the least severe. All AUD symptoms fell on the moderate portion of the severity continuum, except “Withdrawal,” which fell at the lower end of the severe portion. The consumption criterion of 5+/4+ (male/female) at ≥8 times per month demarcated the portion of the severity continuum where AUD symptoms began to occur at a probability of 50%. DIF analysis showed significant gender and age at interview differences for “Hazardous Use,”“Tolerance,” and “Activities Given Up,” but not for the other AUD symptoms. Conclusions: In this American Indian community sample, alcohol abuse and dependence did not represent distinct disorders. Only one AUD symptom was found outside the moderate portion of the underlying AUD severity continuum. Drinking 5+/4+ (male/female) drinks at a frequency of ≥8 times per month during the period of heaviest lifetime drinking was found to function well as both a risk and a diagnostic criterion for lifetime DSM‐IV AUD. DSM‐IV AUD symptom criteria, as currently assessed, may be limited in their ability to capture the full range of symptom severity of AUDs, at least in this high‐risk population.     

The validity of DSM-IV cannabis abuse and dependence criteria in adolescents and the value of additional cannabis use indicators

Aims This study assessed the validity of DSM‐IV cannabis abuse and dependence criteria in an adolescent general population sample and evaluated the usefulness of additional cannabis use indicators. Design and setting Data came from the 2008 Survey on Health and Consumption during the Day of Defense Preparation (ESCAPAD), a cross‐sectional self‐administered survey conducted in France. Participants The analytical sample comprised 3641 adolescents aged 17–19 years who reported cannabis use in the past 12 months. Measurements To assess DSM‐IV criteria of cannabis abuse and dependence, the Munich Composite International Diagnostic Interview (M‐CIDI) was used. As additional cannabis use indicators, daily use, use when alone and use before midday were assessed. Confirmatory factor analyses and two‐parameter logistic item response theory (IRT) models were run. Differential item functioning was assessed using the IRT log‐likelihood ratio approach. Results A one‐factor model comprising both abuse and dependence criteria showed the best fit to the data. Abuse item legal problems showed the greatest severity, whereas dependence items larger/longer and tolerance were found least severe. Discriminatory power was lowest for impaired control and legal problems. Additional cannabis use indicators increased the precision of the overall DSM‐IV criterion set. Gender‐based differential item functioning was observed for items tolerance, withdrawal and use before midday. Conclusion The current DSM conceptualization with two distinct and graded diagnostic classes has limited validity among adolescents. In forthcoming revisions of the classification system, several existing criteria should be revised or dropped, new indicators of substance use disorders should be included and gender should be considered.     

Decision-making in people who relapsed to driving under the influence of alcohol

Background: Alcohol use has been previously associated with neurocognitive impairments, especially in decision‐making cognition. However, some studies have shown little to no decision‐making deficits in relation to different characteristics of people with drinking problems. Relapsing to driving under the influence (DUI) of alcohol is an important issue with legal and psychosocial aspects. We evaluated decision‐making performance in second‐time DUI offenders by using the Iowa Gambling Task (IGT). Method: Thirty‐four male second‐time DUI offenders who had been selected for an official psychoeducational rehabilitation program and 31 healthy controls that were matched for age, education, and alcohol use were included. Along with psychiatric assessment, we applied conventional neuropsychological testing comprising cognitive set‐shifting, response inhibition, attention, and visuospatial abilities. Also, we used the Temperament and Character Inventory (TCI) to assess personality patterns. A computerized version of IGT was used. Results: No significant differences were found between the groups in regard to sociodemographics and conventional neuropsychological testing. DUI participants had significantly higher scores only in “self‐transcendence” subdomain of TCI. On the fifth block of the IGT, DUI participants had significantly lower net scores than controls (U = 380.0, p < 0.05). Also, DUI participants chose significantly more risky decks compared to controls. Conclusions: Our results suggest that there may be subtle decision‐making deficits in DUI participants, which goes undetected on conventional neuropsychological testing and which is not correlated with TCI subdomains related with impulsivity patterns.     

DSM-IV criteria endorsement patterns in alcohol dependence: relationship to severity

Background: In DSM‐IV, the diagnostic threshold for alcohol dependence (AD) is met when a patient presents with at least 3 of 7 criteria. We have computed the predictive value for each individual DSM‐IV AD criterion, and examined subtypes of AD criteria endorsement patterns and their associated severity indicators for community‐dwelling AD individuals. Methods: We utilized data from the 2001 to 2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Positive predictive values (PPV) for DSM‐IV AD were computed for each of the individual criteria. Patterns of criteria endorsements were identified by latent class analysis (LCA). Sociodemographic status, age of onset and duration of AD, patterns of drinking, and drinking treatment history, were conditional on DSM criteria endorsement clusters, as indicators of the respondents’ clinical severity. Results: At the individual criterion level, the single criterion with the greatest PPV was D7—“Activities given up” with ～95% of drinking individuals who endorsed this DSM criterion correctly diagnosed as having DSM‐IV AD. In addition to D7, only D5—“Physical/Psychological problems”, and D6—“Time spent” had a PPV for AD substantially >50%. The LCA of AD endorsement patterns yielded a 6‐cluster solution. The most common response pattern (34.5% of those with AD) was endorsement of 5 criteria: D1—“Quit/Control,” D2—“Larger/Longer,” D3—“Tolerance,” D4—“Withdrawal,” and D5—“Physical/Psychological problems.” The most severe cluster (14%) was comprised of those who were likely to endorse 7/7 criteria. Cluster 1 (8.3%) did not include an endorsement of withdrawal, despite a heavy pattern of alcohol consumption. Unmarried status was associated with more severe criteria endorsement patterns. Conclusions: The present findings indicate a Guttman‐like scaling of endorsement which yielded associations with severity for some of the concurrent indicators included in the analysis. However, severity measures did not always increase with DSM‐IV AD criterion endorsement counts. Although endorsement of 6/7 or 7/7 criteria was associated with greater severity across a variety of indicators, fewer criteria were randomly associated with these measures. These data do not support the use of AD symptom counts as a phenotypic dependent variable. At least 2 extant diagnostic criteria showed relatively low PPV for AD, indicating a need for further assessment of these criteria with new symptoms or re‐wording of the current symptom items.     

Driver fatalities and DUI offenders in New Jersey.

Comparisons of driving and demographic characteristics were made on 407 driver fatalities (DFs) and 407 motorists convicted of driving under the influence (DUI). Significantly more DUI offenders (DOs) than DFs were men and had previous DUIs, accidents, license suspensions, and weekend "index" events. DFs with a blood or brain alcohol concentration (BAC) of 100 or above mg/dL matched most closely with DOs on negative driving events, "index" event days, and demographics. Conversely, DFs with negative BACs differed significantly with DOs on virtually all characteristics. High-BAC DFs and DOs may well be drawn from the same subpopulation of deviant drivers, whereas DFs with negative BACs seem similar to licensed drivers in general.     

An evaluation of the proposed DSM-5 alcohol use disorder criteria using Australian national data

Aims To evaluate the proposed revisions to the DSM‐IV alcohol use disorder criteria using epidemiological data. Design, setting and participants Data came from the 1997 Australian National Survey of Mental Health and Well‐Being. The sample consisted of 10 641 participants aged 18 years and over. Measurements Alcohol use disorders were assessed using a revised version of the CIDI version 2.0. Alcohol use disorders were assessed in all respondents who indicated that they had used alcohol more than 12 times in the previous 12 months (n = 7746). Findings The proposed introduction of a single alcohol use disorder was supported by confirmatory factor analysis (CFA). DSM‐5 criteria were all indicators of a single underlying disorder. Under DSM‐5, the prevalence of alcohol use disorders would increase by 61.7% when compared with those diagnosed under DSM‐IV. When investigating the most appropriate diagnostic threshold, the 3+ threshold maximized agreement between DSM‐IV and DSM‐5 diagnoses, and produced similar prevalence estimates to those yielded by DSM‐IV. Item response theory (IRT) analyses supported the removal of the legal criterion while provided equivocal results for the craving criterion. Conclusions Under the proposed DSM‐IV revisions for alcohol use disorders, estimates of the prevalence in the general population would increase substantially. Whereas evidence supports some of the revisions such as a single underlying disorder, others such as the 2+ threshold for diagnosis of alcohol use disorder and the inclusion of a ‘craving’ criterion may be problematic.     

Assessing Alcohol Problems in Female DWI Offenders

The severity of alcohol problems in a sample of 812 women driving while intoxicated (DWI) offenders enrolled in a Drinking Driver Program in New York State was assessed through the use of multiple measures. These women voluntarily provided information through a self-administered questionnaire completed at the beginning of the program. Classification of alcohol problems based on DSM-III-R criteria was compared with classification based on the use of alcohol-specific and nonalcohol-specific measures of alcohol-related problems. Greater hostility and a larger number of drinks ever consumed accounted for nearly 12% of the variance between no diagnosis and alcohol abuse women, whereas these two variables plus age, race, depression, and having a relative with alcohol problems accounted for nearly 41% of the variance between alcohol abuse and dependent women. A subsample of women within each DSM-III-R diagnostic group showed high risk for later, more severe alcohol problems. Multiple measures of alcohol problems help to elucidate subtle differences in alcohol problems within each of the broad categories specified by the DSM, and should facilitate more appropriate intervention and treatment plans for women DWI offenders with alcohol-related problems.     

Continuous,categorical and mixture models of DSM‐IV alcohol and cannabis use disorders in the Australian community

Aims To apply item response mixture modelling (IRMM) to investigate the viability of the dimensional and categorical approaches to conceptualizing alcohol and cannabis use disorders. Design A cross‐sectional survey assessing substance use and DSM‐IV substance use disorders. Setting and participants A household survey of a nationally representative sample of 10 641 Australia adults (aged 18 years or older). Measurements Trained survey interviewers administered a structured interview based on the Composite International Diagnostic Interview (CIDI). Findings Of the 10 641 Australian adults interviewed, 7746 had drunk alcohol in the past 12 months and 722 had used cannabis. There was no improvement in fit for categorical latent class nor mixture models combining continuous and categorical parameters compared to continuous factor analysis models. The results indicated that both alcohol and cannabis problems can be considered as dimensional, with those with the disorder arrayed along a dimension of severity. Conclusions A single factor accounts for more variance in the DSM‐IV alcohol and cannabis use criteria than latent class or mixture models, so the disorders can be explained most effectively by a dimensional score.     

Greater prevalence of proposed DSM-5 nicotine use disorder compared to DSM-IV nicotine dependence in treated adolescents and young adults

Aims Compared to DSM‐IV nicotine dependence, proposed DSM‐5 nicotine use disorder (NUD) would lower the threshold from three to two symptoms, and increase the number of criteria used for diagnosis from seven to 11. The impact of the proposed changes on nicotine disorder prevalence and the concurrent validity of diagnostic criteria were examined. Design Cross‐sectional survey to compare DSM‐IV and proposed DSM‐5 algorithms. Setting and participants Adolescent (n = 179) and young adult (n = 292) past‐year cigarette users recruited from addictions treatment. Measurements Semi‐structured clinical interview to evaluate DSM‐IV nicotine dependence, and 10 of the 11 proposed DSM‐5 NUD criteria; 30‐day time‐line follow‐back; and the Fagerström Test for Nicotine Dependence (FTND). Findings Prevalence of proposed DSM‐5 NUD (two‐symptom threshold) was much higher (adolescents: 68.7%, young adults: 86.0%) than DSM‐IV nicotine dependence (33.0% and 59.6%, respectively), although prevalence of DSM‐5 severe NUD (four‐symptom threshold) was similar to DSM‐IV nicotine dependence. Concurrent validity analyses in both samples indicated consistent support for DSM‐5 severe NUD diagnosis (four symptoms) but not for the moderate NUD (two symptoms) diagnosis, which had modest relations with only FTND score. IRT analyses indicated strong support for the new craving item, but not for the proposed interpersonal problems and hazardous use items. Conclusions The proposed DSM‐5 nicotine use disorder criteria have substantial limitations when applied to adolescents and young adults, and appear to have low concurrent validity.     

Should symptom frequency be factored into scalar measures of alcohol use disorder severity?

Aims To evaluate whether weighting counts of alcohol use disorder (AUD) criteria or symptoms by their frequency of occurrence improves their association with correlates of AUD. Design and participants Data were collected in personal interviews with a representative sample of US adults interviewed in 1991–92. Analyses were conducted among past‐year drinkers (12+ drinks, n = 18 352) and individuals with past‐year DSM‐IV AUD (n = 2770). Measurements Thirty‐one symptom item indicators, whose frequency of occurrence was measured in eight categories, were used to create unweighted and frequency‐weighted counts of DSM‐IV past‐year AUD symptoms and criteria. Correlates included density of familial alcoholism and past‐year volume of ethanol intake, frequency of intoxication and utilization of alcohol treatment. Findings Although the AUD correlates were associated strongly and positively with the frequency of AUD symptom occurrence, weighting for symptom frequency did not strengthen their association consistently with AUD severity scores. Improved performance of the weighted scores was observed primarily among AUD correlates linked closely with the frequency of heavy drinking and among individuals with AUD. Criterion counts were correlated nearly as strongly as symptom counts with the AUD correlates. Conclusions Frequency weighting may add somewhat to the validity of AUD severity measures, especially those that are intended for use among individuals with AUD, e.g. in clinical settings. For studying the etiology and course of AUD in the general population, an equally effective and less time‐consuming alternative to obtaining symptom frequency may be the use of unweighted criterion counts accompanied by independent measures of frequency of heavy drinking.     

Interactions Among DUI Offender Characteristics and Traditional Intervention Modalities: a long-term recidivism follow-up

Using long-term DUI (Driving Under the Influence of Alcohol) arrest recidivism data from a controlled study of DUI intervention effectiveness, interactions among DUI interventions, age, race, education, and alcohol severity were estimated using logit analysis. Data were collected in a 9-year follow-up study of the Mississippi DUI Probation Project. The effects of short-term interventions (alcohol education schools for low alcohol severity offenders and structured group interventions for high alcohol severity offenders) were specified by educational level. Short-term rehabilitation was modestly effective for those with less than 12 years of education, but less effective or detrimental for the more highly educated. The effects of probation were specified by age and education, being more effective for those under 30 years and 55 years or older than for the middle aged group. Probation was most effective for well-educated older (55 +) offenders. An analysis of the under 30 years group also suggested that probation was especially effective for young well-educated Minority offenders.     

The Dimensionality of DSM-IV Alcohol Use Disorders Among Adolescent and Adult Drinkers and Symptom Patterns by Age, Gender, and Race/Ethnicity

Background: There is limited information on the validity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) alcohol use disorders (AUD) symptom criteria among adolescents in the general population. The purpose of this study is to assess the DSM‐IV AUD symptom criteria as reported by adolescent and adult drinkers in a single representative sample of the U.S. population aged 12 years and older. This design avoids potential confounding due to differences in survey methodology when comparing adolescents and adults from different surveys. Methods: A total of 133,231 current drinkers (had at least 1 drink in the past year) aged 12 years and older were drawn from respondents to the 2002 to 2005 National Surveys on Drug Use and Health. DSM‐IV AUD criteria were assessed by questions related to specific symptoms occurring during the past 12 months. Factor analytic and item response theory models were applied to the 11 AUD symptom criteria to assess the probabilities of symptom item endorsements across different values of the underlying trait. Results: A 1‐factor model provided an adequate and parsimonious interpretation for the 11 AUD criteria for the total sample and for each of the gender–age groups. The MIMIC model exhibited significant indication for item bias among some criteria by gender, age, and race/ethnicity. Symptom criteria for “tolerance,”“time spent,” and “hazardous use” had lower item thresholds (i.e., lower severity) and low item discrimination, and they were well separated from the other symptoms, especially in the 2 younger age groups (12 to 17 and 18 to 25). “Larger amounts,”“cut down,”“withdrawal,” and “legal problems” had higher item thresholds but generally lower item discrimination, and they tend to exhibit greater dispersion at higher AUD severity, particularly in the youngest age group (12 to 17). Conclusions: Findings from the present study do not provide support for the 2 separate DSM‐IV diagnoses of alcohol abuse and dependence among either adolescents or adults. Variations in criteria severity for both abuse and dependence offer support for a dimensional approach to diagnosis which should be considered in the ongoing development of DSM‐V.     

Characteristics of Pathological Gamblers with a Problem Gambling Parent

This analysis compares the characteristics of adult pathological gamblers with and without a problem gambling parent. A sample of 517 individuals with current DSM‐TV pathological gambling was categorized based on presence of a parental problem gambler. Groups were compared on clinical characteristics, gambling severity, gambling‐related problems, and psychiatric comorbidity. Although the groups were similar on most measures, pathological gamblers with at least one problem gambling parent were more likely to have a father with an alcohol abuse/dependence problem; have financial and legal problems; and report daily nicotine use. Females with a problem gambling parent had significantly earlier onset of gambling behavior, were significantly more likely to have a father with an alcohol use disorder, and were significantly more likely to have financial problems secondary to gambling than females without a problem gambling parent. Males with a problem gambling parent were significantly more likely to have a father with an alcohol use disorder and have legal problems secondary to gambling compared to males without a problem gambling parent. Treatment approaches may need to be tailored for specific problems secondary to gambling and gender issues based on the history of having a problem gambling parent.     

Toward efficient and comprehensive measurement of the alcohol problems continuum in college students: the brief young adult alcohol consequences questionnaire

BACKGROUND: Although a number of measures of alcohol problems in college students have been studied, the psychometric development and validation of these scales have been limited, for the most part, to methods based on classical test theory. In this study, we conducted analyses based on item response theory to select a set of items for measuring the alcohol problem severity continuum in college students that balances comprehensiveness and efficiency and is free from significant gender bias. METHOD: We conducted Rasch model analyses of responses to the 48-item Young Adult Alcohol Consequences Questionnaire by 164 male and 176 female college students who drank on at least a weekly basis. An iterative process using item fit statistics, item severities, item discrimination parameters, model residuals, and analysis of differential item functioning by gender was used to pare the items down to those that best fit a Rasch model and that were most efficient in discriminating among levels of alcohol problems in the sample. RESULTS: The process of iterative Rasch model analyses resulted in a final 24-item scale with the data fitting the unidimensional Rasch model very well. The scale showed excellent distributional properties, had items adequately matched to the severity of alcohol problems in the sample, covered a full range of problem severity, and appeared highly efficient in retaining all of the meaningful variance captured by the original set of 48 items. CONCLUSIONS: The use of Rasch model analyses to inform item selection produced a final scale that, in both its comprehensiveness and its efficiency, should be a useful tool for researchers studying alcohol problems in college students. To aid interpretation of raw scores, examples of the types of alcohol problems that are likely to be experienced across a range of selected scores are provided.