Diagnostic validity of Addictions Neuroclinical Assessment indices for alcohol use disorder: Findings from an...

The Addictions Neuroclinical Assessment (ANA) provides a framework for assessing alcohol use disorder (AUD) with indices that may be both mechanistically and diagnostically informative. This study evaluated an array of measures from the three ANA domains in relation to AUD diagnostic status.

This cross-sectional case-control study used receiver operating characteristic (ROC) curves to evaluate diagnostic classification validity using area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Exploratory multivariate models using logistic regression were also evaluated using the same metrics.

Participants were 189 general community adults (52% AUD+, 57% female, M_age = 32) recruited in Hamilton, Ontario, Canada.

Classifiers included measures that conceptually mapped on to the three ANA domains of incentive salience (e.g. alcohol cue reactivity), negative emotionality (e.g. anxiety symptoms, coping motives) and executive function (e.g. NIH-toolkit cognition battery). The clinical criterion (reference standard) was AUD diagnostic status per structured clinical interview.

Incentive salience indices had AUCs from 0.55-0.85; negative emotionality indices had AUCs from 0.67-0.89; and executive function indices had AUCs from 0.51-0.58. For incentive salience, cravings in the cue reactivity paradigm and enhancement motives identified AUD diagnosis above accepted benchmarks for clinical utility. For negative emotionality, coping motives exhibited high diagnostic validity, exceeding clinical utility benchmarks. Exploratory multivariate models combining these indices outperformed the single indicator models.

This study broadly supports using the Addictions Neuroclinical Assessment (ANA) framework for assessing alcohol use disorder (AUD) - specifically the motivational indices from the incentive salience and negative emotionality domains - for the development of next generation diagnostic assessments of AUD using theoretically informed mechanisms. As such, it reflects a further step in moving ANA toward utilization in clinical research and practice.