DSM-IV alcohol abuse and dependence criteria characteristics for recent onset adolescent drinkers

Little is known about the psychometric properties of alcohol abuse and dependence criteria among recent-onset adolescent drinkers, particularly for those who consume alcohol infrequently. This study evaluated how well DSM-IV alcohol dependence criteria measure an alcohol use disorder (AUD) construct for recent onset adolescent drinkers at different levels of drinking frequency.

Data were drawn from the National Survey on Drug Use and Health, a nationally representative sample of 9356 recent-onset adolescent drinkers, aged 12-21, who began drinking within the past year. Multiple group item response theory analysis was conducted to assess the 11 DSM-IV alcohol abuse and dependence criteria.

Criteria most likely to be endorsed at lower AUD severity included "withdrawal," "problems at home, school or work" and "tolerance." The criteria "drinking larger amounts/longer period of time," "unsuccessful efforts to cut down" and "continuing to drink despite related health problems" were more likely to be endorsed at higher AUD severity. Two criteria, "tolerance" and "time spent getting, using or recovering from alcohol" showed differential item functioning between drinking frequency groups (<7 vs. ≥ 7 days in past month), with lower discrimination and severity for more frequent drinkers. DSM-IV criteria were most precise for intermediate levels of AUD severity.

All but two DSM-IV criteria had consistent psychometric properties across drinking frequency groups. Symptoms were most precise for a narrow, intermediate range of AUD severity. Those assessing AUD in recent onset adolescent drinkers might consider additional symptoms to capture the full AUD continuum.