1994 DRAFT DSM-IV CRITERIA FOR ALCOHOL-USE DISORDERS - COMPARISON TO DSM-III-R AND IMPLICATIONS

In 1994, DSM-IV will be published, with new criteria for alcohol abuse and dependence. Implications of the changes in criteria for alcohol u se disorders were investigated by comparing the diagnoses made by the DSM-IV criteria and DSM-III-R criteria. The study was conducted in a s ample of 424 patients in an inpatient alcohol rehabilitation unit in t he New York metropolitan area. DSM-III-R and DSM-IV criteria showed si milar results and high agreement for any alcohol use disorder (abuse a nd dependence combined). Alcohol dependence was also consistently diag nosed with DSM-III-R and DSM-IV criteria. Agreement between DSM-III-R and DSM-IV abuse diagnoses was very low. Compared with DSM-III-R, DSM- IV classified over three times as many patients as alcohol abusers, al though those with alcohol dependence still overwhelmingly dominated th e sample. With some fluctuations, the results were stable over Black, Hispanic, and White subgroups of patients. The direction of the findin gs was consistent with results from a national general population surv ey in that the prevalence of alcohol abuse increased in both studies. However, the clinical results alone would not have suggested the marke d changes in relative prevalence of abuse and dependence that occurred in the general population when DSM-IV criteria were used in place of DSM-III-R. Research on diagnostic criteria limited to patient samples omits important information on the implications of changing aspects of the diagnostic criteria. The need for a coherent theory of alcohol ab use is highlighted.