Toward the DSM-V:: The withdrawal-gate model versus the DSM-IV in the diagnosis of alcohol abuse and dependence
Toward the DSM-V:: The withdrawal-gate model versus the DSM-IV in the diagnosis of alcohol abuse and dependence
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DOI：
10.1037/0022-006x.68.5.799
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发表时间：
2000-10-01
影响因子：
5.9
通讯作者：
Pollock, NK
中科院分区：
文献类型：
--
作者：
Langenbucher, J;Martin, CS;Pollock, NK
《精神疾病诊断与统计手册》（第 4 版；DSM-IV；美国精神病学协会，1994 年）将许多轻度酒精问题病例归为依赖性病例。 DSM-IV 诊断与预测因素和一些并发验证因素的关系不大，并且经常错误地对滥用与依赖的发生进行排序，这可能是由于对生理特征的重视不够。本研究测试了可靠性、综合征患病率、综合征测序以及并发和预测有效性，将 DSM-IV 与戒断门模型 (WGM) 进行了对比，其中戒酒对于依赖性诊断是必要且充分的。对发生滥用或依赖的成人（基线 n = 318）和青少年（基线 n = 214）的临床样本进行了 DSM-IV 酒精症状和问题严重程度的外部测量的评估，并在 6 个月（成人）和 12 个月（成人和青少年）时进行了重新访谈。在 DSM-IV 依赖病例中，WGM 将 32% 的成年人和 80% 的青少年转入滥用类别，使这两个类别的症状更加严重，但对总酒精诊断患病率的影响可以忽略不计。 WGM 比 DSM-IV 更可靠，并且在更多病例中，在依赖之前按时间顺序排列滥用。在大多数指标上，WGM 的并发有效性和预测有效性均优于 DSM-IV。如果未来的诊断系统需要物质依赖戒断证据，那么它们可能会更加可靠和有效。
The Diagnostic and Statistical Manual of Menial Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) classifies as dependent many cases of mild alcohol problems. DSM-IV diagnoses have modest relationships with predictive and some concurrent validators and often improperly sequence the onset of abuse versus dependence, perhaps due to insufficient emphasis on physiological features. Testing reliability, syndrome prevalence, syndrome sequencing, and concurrent and predictive validity, this study contrasted the DSM-IV with the Withdrawal-Gate Model (WGM), in which alcohol withdrawal is necessary and sufficient for the dependence diagnosis. Clinical samples of adults (baseline n = 318) and adolescents (baseline n = 214) meeting abuse or dependence were assessed for DSM-IV alcohol symptoms and external measures of problem severity and reinterviewed at 6 (adults) and 12 months (adults and adolescents). Among DSM-IV dependent cases, the WGM shifted 32% of adults and 80% of adolescents to the abuse category, making both categories more symptomatically severe, but had a negligible effect on the prevalence of total alcohol diagnoses. The WGM was more reliable than the DSM-IV and temporally sequenced abuse before dependence in a greater number of cases. The WGM was superior to the DSM-IV in concurrent and predictive validity on most measures. Future diagnostic systems may be more reliable and valid if they require evidence of withdrawal for substance dependence.