Alcohol and Alcoholism Advance Access originally published online on May 9, 2005
Alcohol and Alcoholism 2005 40(4):314-322; doi:10.1093/alcalc/agh166
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THE CRAVING WITHDRAWAL MODEL FOR ALCOHOLISM: TOWARDS THE DSM-V. IMPROVING THE DISCRIMINANT VALIDITY OF ALCOHOL USE DISORDER DIAGNOSIS
Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands, 1 Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands, 2 Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands and 3 Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
* Author to whom correspondence should be addressed at: Department of Psychiatry, University Medical Centre Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands. Tel.: +31 30 2506370; Fax: +31 30 2505443; E-mail: h.debruijn-2{at}psych.azu.nl
Received 12 October 2004; first review notified 3 March 2005; in revised form 3 April 2005; accepted 14 April 2005
Aims: To compare the discriminant validity of the DSM-IV and the ICD-10 classification of alcohol use disorders (AUD) with an alternative classification, 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 AUD criteria. Methods: Data were derived from The Netherlands Mental Health Survey and Incidence Study, a large representative sample of the general Dutch population. In the present study, only non-abstinent subjects were included (n = 6041). Three diagnostic systems (DSM-IV, ICD-10, and CWM) were compared using the following discriminant variables: alcohol intake, psychiatric comorbidity, functional status, familial alcohol problems, and treatment sought. Results: The year prevalence of CWM alcohol dependence was lower than the prevalence of ICD-10 and DSM-IV dependence (0.3% vs 1.4% and 1.4%). The year prevalence of abuse was similar for CWM and DSM-IV (4.7 and 4.9%), but lower for ICD-10 harmful use (1.7%). 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 contrast, the CWM distinctions between normality and abuse, and between abuse, and dependence were significant for most of the discriminant variables. Conclusion: This study indicates that CWM improves the discriminant validity of AUD diagnoses. The predictive validity of the CWM for alcohol and other substance use disorders remain to be studied.
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