DSM-IV alcohol abuse due to hazardous use: a less severe form of abuse?

A majority of individuals that meet criteria for alcohol abuse based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), do so by endorsing the hazardous use criterion. We used a large, nationally representative data set to investigate whether alcohol abuse due to hazardous use is distinct from abuse attributable to other abuse criteria and whether abuse due to hazardous use is a less severe form of alcohol abuse.

Two waves of data, collected 3 years apart, from 34,653 individuals who participated in the National Epidemiological Survey on Alcohol and Related Conditions were used. Logistic regression was used to compare those with alcohol abuse due to hazardous use and those with alcohol abuse due to other criteria across several sociodemographic and psychiatric correlates at Wave 1 and across alcohol-related outcomes at the 3-year follow-up. Those with a lifetime history of alcohol dependence at Wave 1 were excluded.

Abuse due to hazardous use was more commonly noted in older individuals, those not living below the poverty line, and those without nicotine dependence and was more likely to be noted in White participants. Abuse due to hazardous use was also associated with lower rates of problematic drinking, alcohol dependence, and help seeking at 3-year follow-up.

Individuals endorsing hazardous use are at greater risk than those endorsing no abuse criteria, but abuse due to hazardous use may represent a less severe form of alcohol-use disorders. This is troubling, because current DSM conceptualizations allow for endorsement of hazardous use to denote alcohol-use disorders. Future classifications may wish to consider a higher threshold for alcohol-use disorders, particularly when hazardous use is endorsed.