Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 170
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Boness, Cassandra L. Lane, Sean P. and Sher, Kenneth J. 2016. Assessment of Withdrawal and Hangover is Confounded in the Alcohol Use Disorder and Associated Disabilities Interview Schedule: Withdrawal Prevalence is Likely Inflated. Alcoholism: Clinical and Experimental Research, Vol. 40, Issue. 8, p. 1691.

    Caetano, Raul Vaeth, Patrice A.C. Santiago, Katyana and Canino, Glorisa 2016. The dimensionality of DSM5 alcohol use disorder in Puerto Rico. Addictive Behaviors, Vol. 62, p. 20.

    Hart, Amy B. Lynch, Kevin G. Farrer, Lindsay Gelernter, Joel and Kranzler, Henry R. 2016. Which alcohol use disorder criteria contribute to the association ofADH1Bwith alcohol dependence?. Addiction Biology, Vol. 21, Issue. 4, p. 924.

    Lago, Luise Bruno, Raimondo and Degenhardt, Louisa 2016. Concordance of ICD-11 and DSM-5 definitions of alcohol and cannabis use disorders: a population survey. The Lancet Psychiatry, Vol. 3, Issue. 7, p. 673.

    Lane, S. P. Steinley, D. and Sher, K. J. 2016. Meta-analysis of DSM alcohol use disorder criteria severities: structural consistency is only ‘skin deep’. Psychological Medicine, Vol. 46, Issue. 08, p. 1769.

    Malone, Marisa and Hoffmann, Norman 2016. A Comparison ofDSM-IV VersusDSM-5 Substance Use Disorder Diagnoses in Adolescent Populations. Journal of Child & Adolescent Substance Abuse, p. 1.

    Olsson, Craig A Romaniuk, Helena Salinger, Jodi Staiger, Petra K Bonomo, Yvonne Hulbert, Carol and Patton, George C 2016. Drinking patterns of adolescents who develop alcohol use disorders: results from the Victorian Adolescent Health Cohort Study. BMJ Open, Vol. 6, Issue. 2, p. e010455.

    Schomerus, G. Angermeyer, M.C. Baumeister, S.E. Stolzenburg, S. Link, B.G. and Phelan, J.C. 2016. An online intervention using information on the mental health-mental illness continuum to reduce stigma. European Psychiatry, Vol. 32, p. 21.

    Zucker, Robert A. Hicks, Brian M. and Heitzeg, Mary M. 2016. Developmental Psychopathology.

    Caetano, Raul 2015. A decade after NESARC: what has it told us?. Addiction, Vol. 110, Issue. 3, p. 375.

    Castaldelli-Maia, João Mauricio Wang, Yuan-Pang Borges, Guilherme Silveira, Camila M. Siu, Erica R. Viana, Maria C. Andrade, Arthur G. Martins, Silvia S. and Andrade, Laura H. 2015. Investigating dimensionality and measurement bias of DSM-5 alcohol use disorder in a representative sample of the largest metropolitan area in South America. Drug and Alcohol Dependence, Vol. 152, p. 123.

    Cherpitel, Cheryl J. and Ye, Yu 2015. Performance of the RAPS4/RAPS4-QF for DSM-5 compared to DSM-IV alcohol use disorders in the general population: Data from the 2000–2010 National Alcohol Surveys. Drug and Alcohol Dependence, Vol. 151, p. 258.

    Fairman, Brian J. 2015. Cannabis problem experiences among users of the tobacco–cannabis combination known as blunts. Drug and Alcohol Dependence, Vol. 150, p. 77.

    Hagman, Brett T. 2015. Toward Efficient Screening for DSM-5 Alcohol Use Disorders in College Students. Addictive Disorders & Their Treatment, Vol. 14, Issue. 1, p. 1.

    Harford, Thomas C. Yi, Hsiao-ye Chen, Chiung M. and Grant, Bridget F. 2015. Psychiatric Symptom Clusters as Risk Factors for Alcohol Use Disorders in Adolescence: A National Study. Alcoholism: Clinical and Experimental Research, Vol. 39, Issue. 7, p. 1174.

    Hasin, Deborah S. and Grant, Bridget F. 2015. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Social Psychiatry and Psychiatric Epidemiology, Vol. 50, Issue. 11, p. 1609.

    Johnson, J. Aaron Bembry, Whitney Peterson, Justin Lee, Anna and Seale, J. Paul 2015. Validation of the ASSIST for Detecting Unhealthy Alcohol Use and Alcohol Use Disorders in Urgent Care Patients. Alcoholism: Clinical and Experimental Research, Vol. 39, Issue. 6, p. 1093.

    Jonas, Katherine G. and Markon, Kristian E. 2015. The Encyclopedia of Clinical Psychology.

    Kapoor, Manav and Agrawal, Arpana 2015. Commentary: Sex Differences in the Pathways to Symptoms of Alcohol Use Disorder: A Study of Opposite-Sex Twin Pairs. Alcoholism: Clinical and Experimental Research, Vol. 39, Issue. 6, p. 950.

    Karriker-Jaffe, Katherine J. Witbrodt, Jane and Greenfield, Thomas K. 2015. Refining Measures of Alcohol Problems for General Population Surveys. Alcoholism: Clinical and Experimental Research, Vol. 39, Issue. 2, p. 363.


Toward an alcohol use disorder continuum using item response theory: results from the National Epidemiologic Survey on Alcohol and Related Conditions

  • DOI:
  • Published online: 01 July 2006

Background. Item response theory (IRT) was used to determine whether the DSM-IV diagnostic criteria for alcohol abuse and dependence are arrayed along a continuum of severity.

Method. Data came from a large nationally representative sample of the US population, 18 years and older. A two-parameter logistic IRT model was used to determine the severity and discrimination of each DSM-IV criterion. Differential criterion functioning (DCF) was also assessed across subgroups of the population defined by sex, age and race-ethnicity.

Results. All DSM-IV alcohol abuse and dependence criteria, except alcohol-related legal problems, formed a continuum of alcohol use disorder severity. Abuse and dependence criteria did not consistently tap the mildest or more severe end of the continuum respectively, and several criteria were identified as potentially redundant. The drinking in larger amounts or for longer than intended dependence criterion had the greatest discrimination and lowest severity than any other criterion. Although several criteria were found to function differentially between subgroups defined in terms of sex and age, there was evidence that the generalizability and validity of the criterion forming the continuum remained intact at the test score level.

Conclusions. DSM-IV diagnostic criteria for alcohol abuse and dependence form a continuum of severity, calling into question the abuse–dependence distinction in the DSM-IV and the interpretation of abuse as a milder disorder than dependence. The criteria tapped the more severe end of the alcohol use disorder continuum, highlighting the need to identify other criteria capturing the mild to intermediate range of the severity. The drinking larger amounts or longer than intended dependence criterion may be a bridging criterion between drinking patterns that incur risk of alcohol use disorder at the milder end of the continuum, with tolerance, withdrawal, impaired control and serious social and occupational dysfunction at the more severe end of the alcohol use disorder continuum. Future IRT and other dimensional analyses hold great promise in informing revisions to categorical classifications and constructing new dimensional classifications of alcohol use disorders based on the DSM and the ICD.

Corresponding author
Laboratory of Epidemiology and Biometry, Room 3077, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, MS 9304, Bethesda, MD 20892-9304, USA. (Email:
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *