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Thursday, August 18, 2011

ESBRA 2011, European Society for Biomedical Research on Alcoholism, Vienna, Austria, September 4–7, 2011 SYMPOSIA ABSTRACTS


S01

ALCOHOL USE DISORDER DSM V DRAFT CRITERIA: DEVELOPMENT AND APPLICABILITY IN ADOLESCENT AND ADULT SAMPLES


S01.1
DSM V DEVELOPMENT AND APPLICABILITY TO ADOLESCENT/YOUNG ADULT POPULATIONS

  1. K. Bucholz1,
  2. A. Agrawal1,
  3. J. Kramer2,
  4. M. Schuckit3 and
  5. S. Kuperman2

Author Affiliations

  1. 1Washington U. School of Medicine, St. Louis, MO, USA
  2. 2University of Iowa, Iowa City, IA, USA
  3. 3University of California-San Diego, San Diego, CA, USA

Abstract

Background. Revision of the DSM diagnostic criteria is underway; proposed changes have been posted for review. Data from clinical, general population, family and twin samples from the USA and across the world have been analyzed by the substance-related workgroup to inform the proposed revisions to criteria for substance use disorders. Data from both adults and adolescents have been studied. In this presentation, we will examine the proposed criteria for alcohol use disorder (AUD) in a young sample from the Collaborative Study on the Genetics of Alcoholism (COGA), a high-risk family study established to identify the genes for alcoholism, and in which data are being collected every 2 years from youth aged 12–25. The proposed changes to be studied include: combining abuse and dependence into a single disorder, eliminating as a criterion recurrent legal problems, adding a new item reflecting craving and using a cut point of 2 or more (of 11) symptoms to indicate affected status.

Method. Data on AUD symptoms from adolescents and young adults were analyzed using factor analysis and IRT models. One- to four-factor models were fitted to 12 lifetime symptoms (n = 1635 individuals drinkers, mean age 17.9, 48% female). Agreement (kappa) with DSM-IV abuse/dependence was examined.

Results. Exploratory factor analysis revealed strong evidence for one factor, with loadings substantial (>0.70) for most items. Craving fit well with the other items. Results were unchanged when legal problems were eliminated. IRT results indicated good fit and craving had good discrimination but high difficulty. The cutpoint of two symptoms achieved the highest agreement (kappa) with DSM-IV abuse/dependence diagnosis and evinced a modest 5.6% increase in prevalence.

Conclusions. Proposed changes for DSM-V appear to work well in a young sample for AUD, but analyses need to be repeated in a less-selected sample and for other substances to ensure that these results are generalizable.

S01.2
PREDICTORS OF CONTINUED DSM-V ALCOHOL DEPENDENCE INTO EARLY ADULTHOOD

  1. V. Hesselbrock,
  2. M. Hesselbrock,
  3. G. Chan and
  4. COGA Colleagues

+ Author AffiliationsAlign Left

  1. University of Connecticut School of Medicine, Farmington, CT, USA

Abstract

This presentation describes results from a 5-year follow-up of 4983 adolescent drinkers initially assessed between the ages of 14–18 (T1) who are participating in the Collaborative Study on the Genetics of Alcoholism (COGA). The sample, now 19–23 years old (T2), is ethnically diverse and contains a similar number of males and females. Subjects were assessed at each time point with a structured research diagnostic interview [adolescent or adult version of the Semi-structured Assessment for the Genetics of Alcoholism (SSAGA)]. At T2, subjects were divided into four groups: no DSM-V alcohol dependence diagnosis at either time point; new cases—affected only at T2 but not at T1; remitters—affected only at T1 but not at T2; and DSM-V alcohol dependent at both T1 and T2. Demographic information, religiosity, drinking history variables and co-occurring psychiatric conditions were used to identify an optimal set of baseline/T1 predictors of group membership at the end of the follow-up (T2) interval. Using simple bivariate analyses, most predictors were associated with group membership. However, most of the predictors were highly inter-correlated. Logistic regression analyses suggest that early drinking characteristics (including the age of first drink, the age of first regular drinking) and the prevalence of dependence symptoms at T1 are important predictors of both new cases and continued dependence, while demographic factors (gender, educational level, income) and drinking variables predict remission or no dependence at T2. Ethnic differences consistent with the US epidemiologic data on alcohol use were also observed. (This study was supported by U10AA AA08403 and P50AA03510.)

S01.3
THE CRAVING-WITHDRAWAL MODEL FOR ALCOHOLISM: TOWARDS THE DSM-V

  1. C. Hagestein-de Bruijn

+ Author Affiliations

  1. MC Haaglanden, Den Haag, Netherlands

Abstract

Background. The main drawbacks of the DSM-IV classification of alcohol use disorders are the poor validity of the abuse diagnosis and the absence of craving in the diagnostic criteria. In this presentation, an alternative classification is introduced, the Craving Withdrawal Model (CWM). CWM requires craving and withdrawal for the diagnosis of alcohol dependence and raises the alcohol abuse threshold to two DSM-IV alcohol use disorder criteria. The discriminant validity of this model is compared with DSM-IV and ICD-10 in two different samples. Furthermore, the course of alcohol use disorders according to the different classification systems is studied in the general population.

Methods. The validity of DSM-IV is compared with CWM and ICD-10 in two samples. The first study compares the discriminant validity of DSM-IV to CWM in a male sample of treatment seeking alcoholics, non-treatment seeking heavy drinkers and psychiatric outpatients, using the following discriminant variables: alcohol intake, biochemical markers and functional status. Furthermore, the discriminant validity of DSM-IV is compared with ICD-10 and CWM, using data from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). This is a large representative sample of the general Dutch population. Discriminant validators are: alcohol intake, psychiatric co-morbidity, functional status, familial alcohol problems and treatment seeking. Finally, the one- and three-year course of alcohol use disorders according to DSM-IV, ICD-10 and CWM is examined, using the follow-up data from NEMESIS.

Results. Both studies found that DSM-IV resulted in a poor distinction between normality and abuse and ICD-10 resulted in a poor distinction between harmful use and dependence in the epidemiological study, whereas the CWM distinctions between normality and abuse and between abuse and dependence were significant for most of the discriminant variables in both studies. These results indicate that CWM improves the discriminant validity of AUD diagnoses.

S01.4
POTENTIAL DIAGNOSTIC THRESHOLDS AND SEVERITY OF DSM V ALCOHOL USE DISORDERS

  1. U. Preuss1,
  2. S. Watzke1,
  3. C. Fehr2,
  4. G. Koller3,
  5. M. Soyka4 and
  6. F. M. Wurst5

+ Author Affiliations

  1. 1Department of Psychiatry, Psychotherapy, Psychosomatics, Halle, Germany
  2. 2Department of Psychiatry, Mainz, Germany
  3. 3Department of Psychiatry, München, Germany
  4. 4Privatklinik Meiringen, Meiringen, Switzerland
  5. 5Paracelsus University, Salzburg, Austria

Abstract

DSM V-criteria of the diagnostic category alcohol use disorder have been proposed. Eleven criteria have been proposed which try to overcome some of the limitations of the DSM IV distinction between alcohol abuse and alcohol dependence. The aims of the analyses of two samples are, to confirm the dimensionality of DSM V criteria, determine a potential diagnostic threshold and severity of an alcohol use disorder. This analysis takes advantage of the WHO/ISBRA Study on State and Trait Markers of Alcohol Use and Dependence dataset. Subjects included into the analyses (n = 1424) were aged 18 and over and were recruited from five countries: Australia (Sydney), Brazil (São Paulo), Canada (Montreal), Finland (Helsinki) and Japan (Sapporo). All DSM V criteria were determined in this sample by a structured interview. The CIGAR (Collaborative Initiative on Genetics in Alcoholism in CentRal Europe) sample of inpatient alcohol-dependent individuals from Germany was used to determine DSM V symptom severity (n = 635). Again, DSM V criteria were obtained using structured interviews (SSAGA, CIDI/DIA-X). The results indicate that dimensionality of DSM V alcohol use disorder criteria can be confirmed by IRT (Item Response Theory) statistics. However, using the criteria, a diagnostic threshold to distinguish between the presence or the absence of the disorder is difficult to determine. Furthermore, a proposal is made, how alcohol use disorder severity can be defined by DSM V clinical symptoms and this proposal can be confirmed using a number of external validitors (e.g. comorbidity with mental disorders, alcohol consumption markers, suicidal behavior and rate of genetic risk variants).


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