The three year course of alcohol use disorders in the general population: DSM-IV, ICD-10 and the Craving Withdrawal Model

Abstract

Aims: To determine the course of alcohol use disorders (AUD) in a prospective general population study using three different classification systems: Diagnostic and Statistical Manual version IV (DSM-IV), International Classification of Diseases version 10 (ICD-10) and the craving withdrawal model (CWM). The latter is an alternative classification, which requires craving and withdrawal for alcohol dependence and raises the alcohol abuse threshold to two criteria.

Design, setting and participants: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a large (n=7,076) representative general population study with a baseline and 1- and 3-year follow-up assessments.

Measurements: Diagnostic status according to DSM-IV, ICD-10 and CWM at baseline and at follow-up was established using a structured interview (Composite International Diagnostic Interview: CIDI).

Findings: DSM-IV abuse, ICD-10 harmful use and CWM abuse all showed a favourable course with remission rates of 81, 89 and 71%, respectively, at 1-year follow-up and 85, 92 and 79% at 3-year follow-up. Dependence according to DSM-IV, ICD-10 and CWM had a somewhat less favourable course, with remission rates (no dependence) of 67, 67 and 57% at 1-year follow-up and 74, 69 and 73% at 3-year follow-up, respectively. Subjects who were remitted at 1-year follow-up showed relapse-rates of 0-14% for dependence and 4-12% for abuse at 3-year follow-up. Although CWM diagnoses tended towards greater diagnostic stability than DSM-IV and ICD-10, most differences were not significant.

Conclusion: The conviction that addiction is a chronic relapsing disease may apply to treatment-seeking alcoholics, but our data show a far more favourable course of alcohol use disorders in the general population.