Refining measures of alcohol problems for general population surveys

There is a need to improve classification of alcohol use disorders (AUDs) in general population surveys. We developed and tested follow-up questions for 2 commonly reported symptom domains (withdrawal and larger/longer) to assess effects on Diagnostic and Statistical Manual-5 AUD classification.

Telephone interviews recontacted a selective follow-up sample of respondents under age 46 from the 2010 National Alcohol Survey with at least 1 lifetime AUD symptom (n = 244). Items included detailed questions about past-year AUD symptoms. Three items (vomiting, sweating, irritability) were recoded as acute intoxication rather than withdrawal if they most recently occurred within 8 hours of stopping drinking. The larger/longer criterion was recoded as socially motivated if respondents endorsed "got caught up in drinking with a group of friends" and not "feel compelled to drink and just can't stop" as a reason for drinking more than intended.

Of 225 current drinkers, 11% reported past-year withdrawal, with 28% of those reporting acute intoxication instead of physical withdrawal. Adjusting past-year withdrawal classification reduced AUD prevalence by 6%. A minority (12%) reported the past-year larger/longer criterion. Of those, 50% indicated social reasons for drinking more than intended, rather than compulsion to drink. Adjusting the past-year larger/longer criterion reduced AUD prevalence by 8%. Accounting for both adjustments reduced AUD prevalence by 13%. Cases that met AUD criteria after both adjustments were substantially heavier drinkers than those that were reclassified.

Follow-up items could be implemented in epidemiologic studies with minimal response burden and may help reduce misclassification of AUD.