Diagnostic orphans: Adolescents with alcohol symptoms who do not qualify for DSM-IV abuse or dependence diagnoses

Objective: Little is known about the validity of the DSM-IV criteria for al cohol use disorders when applied to adolescents. This report describes a gr oup of "diagnostic orphans," adolescents with one or two DSM-IV alcohol dep endence symptoms who do not meet the DSM-IV criteria for alcohol abuse or a lcohol dependence. Method: The study included 199 male and 173 female subje cts aged 13-19 years, All subjects were regular drinkers, recruited from co mmunity sources and alcohol treatment programs. At baseline and at I-year f ollow-up, DSM-IV alcohol use disorders were assessed with a version of the Structured Clinical Interview for DSM-III-R, modified for DSM-IV criteria. Results: Diagnostic orphans represented 31% of the drinkers without an alco hol use disorder. The orphans were similar to the alcohol abusers and dissi milar to the other drinkers in alcohol and substance use patterns and in th e course of alcohol problems over 1 year. Conclusions: The results indicate limitations of the DSM-IV criteria for alcohol use disorders when applied to adolescents. Diagnostic orphans should be considered separately from oth er drinkers in research and treatment efforts.