Proposed new rules may label more people as problem drinkers, study shows

Reuters | Jan 3, 2011

by Megan Brooks

Proposed revisions to formal criteria for alcohol abuse and dependence would label significantly more people as problem drinkers, a new study from Australia shows.

“Our analyses show that the proposed changes would lead to about a 60% increase in the diagnosis of alcohol use disorders in Australia, from 6.0% to 9.7%,” Louise Mewton, from the National Drug and Alcohol Research Center, University of New South Wales in Sydney, told Reuters Health by email.

The number of people falling into the alcohol use disorders category under proposed revisions to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), currently in its fourth edition, would undoubtedly increase in other countries as well.

Whether this would be helpful or not is unclear. “Our analyses cannot be used to determine whether this increase is good or bad,” Mewton said.

Further study, she added, is needed to figure out whether or not those who land in the alcohol use disorder category suffer clinically meaningful alcohol-related problems as well as whether they get help as a result of qualifying for this new category and receiving a formal diagnosis.

If people diagnosed with an alcohol use disorder under the new criteria do experience substantial disability and impairment, “then diagnosis, early intervention and further treatment would be appropriate,” she said.

The DSM-IV is the “bible” for mental health doctors because it provides definitions, symptoms and characteristics for mental disorders, including alcohol disorders.

Publication of the fifth edition of the book, the DSM-5, in May 2013 “will mark one the most anticipated events in the mental health field,” according to the project website.

There have been four major revisions to the DSM-IV alcohol use disorder criteria proposed for the new manual. First, two separate disorders under DSM-IV, “alcohol abuse” and “alcohol dependence,” would be combined into a single “alcohol use disorder” in the DSM-5.

Second, in order to be diagnosed with an alcohol use disorder of moderate severity in DSM-5 a person needs to report two or three of the proposed criteria. In order to be diagnosed with a highly severe alcohol use disorder, a person needs to report four or more of the proposed criteria.

Third, the DSM-IV criterion of alcohol-related legal problems — that is, reporting repeated legal problems as a result of alcohol use — is gone from the DSM-5.

Fourth, a new criterion representing “craving” has been added to the DSM-5. “The craving criterion was included due to evidence indicating it is a key clinical feature of problematic alcohol use,” Mewton explained.

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