The prognostic implications of DSM-IV abuse criteria in drinking adolescents

The validity of the DSM-IV diagnostic criteria for alcohol abuse has been questioned, and additional issues have been raised regarding the performance of this label in adolescents. While future diagnostic manuals might alter the approach to abuse, it is worthwhile to evaluate the implications of the current definition that has been in place since 1994.

Six hundred and sixteen 12-19-year-old subjects (mean 16.5 years) were offspring identified in the Collaborative Study on the Genetics of Alcoholism (COGA) protocol who had ever consumed a full drink and who were followed up 5 years later using age-appropriate semi-structured interviews. Following the guidelines for evaluating the utility of the diagnostic labels of Robins and Guze [Robins, E., Guze, S.B., 1970. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am. J. Psychiat. 126, 983-987], the subjects with alcohol abuse were compared with other groups regarding clinical validators and clinical course.

At initial interview, the pattern of most alcohol use and problem variables were least severe for teenagers with no diagnosis, intermediate for those with abuse, and the highest for individuals with alcohol dependence. At follow-up, 50% of those with initial abuse maintained that diagnosis, 19% developed dependence, and 31% had no DSM-IV diagnosis. Baseline alcohol abuse predicted follow-up diagnosis even when evaluated along with initial demographic and substance use characteristics.

These results support some assets for the DSM-IV alcohol abuse criteria in these adolescents, including indications of both cross-sectional and predictive validities. Additional studies will need to compare the current abuse label with other possible approaches.