Towards DSM-V: Exploring Diagnostic Thresholds for Alcohol Dependence and Abuse

Aims: The expected release of the DSM-V in 2012 has renewed the longstanding debate around whether alcohol use disorders are best conceptualized as dimensional or categorical constructs. The current study aimed to validate the current diagnostic thresholds for alcohol dependence and abuse using epidemiological indicators including mental health, disability, psychological distress, functional impairment, service use, suicidality and early age of drinking onset. Methods: Dichotomous variables were created to allocate a representative sample of Australian adult drinkers (n = 4920) above and below each possible threshold for both disorders. Regression analyses were conducted to assess group differences at each threshold for each epidemiological indicator. Results: There was some albeit limited support for the current diagnostic threshold of three criteria for alcohol dependence and one criterion for abuse. A number of other cut-offs also showed consistent variation for both disorders. Conclusions: It is essential to define diagnostic thresholds in a systematic way. The current diagnostic thresholds for alcohol dependence and abuse are adequate but require further validation using a variety of methods and external indicators. Combining these disorders in some way may also prove useful as well as including other potential diagnostic criteria in future research.