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

Abstract

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.

Graph 1. Criterion response curves for DSM-IV abuse and dependence criteria in the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP)-All Emergency Departments combined

Graph 2. Criterion response curves for DSM-IV abuse and dependence criteria and 5+Weekly/Monthly for Men/Women in each study site. (US-Santa Clara)

Graph 3. Criterion response curves for DSM-IV abuse and dependence criteria and 5+Weekly/Monthly for Men/Women in each study site. (Mexico-Pachuca)

Graph 4. Criterion response curves for DSM-IV abuse and dependence criteria and 5+Weekly/Monthly for Men/Women in each study site. (Mar del Plata-Argentina)

Graph 5. Criterion response curves for DSM-IV abuse and dependence criteria and 5+Weekly/Monthly for Men/Women in each study site. (Warsaw & Sosnowiec, Poland)

Graph 6. Test response curves (TRCs) for DSM-IV abuse and dependence criteria, and 5+Weekly/Monthly for Men/Women by each study site