Differences in the Profiles of DSM-IV and DSM-5 Alcohol Use Disorders: Implications for Clinicians
Differences in the Profiles of DSM-IV and DSM-5 Alcohol Use Disorders: Implications for Clinicians
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DOI：
10.1111/j.1530-0277.2012.01930.x
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发表时间：
2013-01-01
影响因子：
3.2
通讯作者：
Grant, Bridget F.
中科院分区：
文献类型：
--
作者：
Dawson, Deborah A.;Goldstein, Rise B.;Grant, Bridget F.
DSM-5修订版对酒精使用障碍（AUD）诊断的影响的现有信息存在差距，包括缺失对理解修订版对临床实践的影响至关重要的信息。方法来自全国酒精及相关疾病流行病学调查第2波的数据被用于比较AUD的严重程度、酒精消费和治疗、社会人口学和健康特征，精神共病在DSM-IV滥用与DSM-5中度AUD和DSM-IV依赖与DSM-5重度AUD的个体中存在。对于每一对疾病，我们还比较了3个相互排斥的组：个人积极的DSM-IV疾病，那些积极的DSM-5疾病，和那些积极的both.Results而80.5%的个人积极的DSM-IV的依赖是积极的DSM-5严重AUD，只有58.0%的滥用是积极的中度AUD。DSM-IV依赖和DSM-5严重AUD个体的特征几乎相同。唯一显著（p < 0.005）的差异是前者的AUD标准更多，反映了重度AUD相对于依赖性的更高标准阈值（>= 4 vs. >= 3）。相比之下，DSM-5中度AUD和DSM-IV滥用的个人资料差异很大。前者比后者支持更多的AUD标准，有更高的生理依赖率，更少的可能是白色个体和男性，更低的收入，更少的可能有私人健康保险而更多的可能有公共健康保险，以及更高的共病焦虑障碍水平。然而，临床医生可能会面临一些变化，涉及AUD严重程度范围较轻的病例的适当筛查和转诊，并且这些报销机制可能会从私营部门略微转移到公共部门。
Background Existing information on consequences of the DSM-5 revision for the diagnosis of alcohol use disorders (AUD) has gaps, including missing information critical to understanding implications of the revision for clinical practice.Methods Data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used to compare AUD severity, alcohol consumption and treatment, sociodemographic and health characteristics, and psychiatric comorbidity among individuals with DSM-IV abuse versus DSM-5 moderate AUD and DSM-IV dependence versus DSM-5 severe AUD. For each pair of disorders, we additionally compared 3 mutually exclusive groups: individuals positive solely for the DSM-IV disorder, those positive solely for the DSM-5 disorder, and those positive for both.Results Whereas 80.5% of individuals positive for DSM-IV dependence were positive for DSM-5 severe AUD, only 58.0% of those positive for abuse were positive for moderate AUD. The profiles of individuals with DSM-IV dependence and DSM-5 severe AUD were almost identical. The only significant (p < 0.005) difference, more AUD criteria among the former, reflected the higher criterion threshold (>= 4 vs. >= 3) for severe AUD relative to dependence. In contrast, the profiles of individuals with DSM-5 moderate AUD and DSM-IV abuse differed substantially. The former endorsed more AUD criteria, had higher rates of physiological dependence, were less likely to be White individuals and men, had lower incomes, were less likely to have private and more likely to have public health insurance, and had higher levels of comorbid anxiety disorders than the latter.Conclusions Similarities between the profiles of DSM-IV and DSM-5 AUD far outweigh differences; however, clinicians may face some changes with respect to appropriate screening and referral for cases at the milder end of the AUD severity spectrum, and the mechanisms through which these will be reimbursed may shift slightly from the private to public sector.