Abstract
Background: Endorsement of specific Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) alcohol use disorder (AUD) criteria have been shown to change significantly over time in men in their thirties who have persistent or recurrent AUD. However, few studies have documented whether the endorsement of AUD items changes over time in younger individuals or in women. We evaluated changes in the endorsement of AUD criteria in 377 men and women with persistent or recurrent AUD during their twenties. Methods: Information on AUD-item endorsement over time was available for 223 men and 154 women aged 20-25 with persistent or recurrent AUD in at least three interviews in the Collaborative Study on the Genetics of Alcoholism. The statistical significance of endorsement changes over time was evaluated using the related-sample Cochran's Q test for the full sample and for men and women separately. Additional analyses evaluated sex differences in the patterns of change. Results: In the full sample, the predominant pattern was for a significant increase in the rates of endorsement for six of the seven alcohol dependence criteria but not in the four abuse criteria. A similar pattern was seen within men, but women had significant changes in only three of the seven dependence criteria. Conclusions: Endorsement of the seven alcohol dependence criteria among individuals with persistent or recurrent AUD in their twenties generally increased, but few changes were observed in the rates of endorsement of the four abuse criteria. These results are discussed in terms of how they reflect on the nature of AUD and the DSM criteria.
| Original language | English |
|---|---|
| Pages (from-to) | 919-929 |
| Number of pages | 11 |
| Journal | Alcoholism: Clinical and Experimental Research |
| Volume | 47 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 2023 |
Keywords
- alcoholism
- diagnosis
- longitudinal
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In: Alcoholism: Clinical and Experimental Research, Vol. 47, No. 5, 05.2023, p. 919-929.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Changes over time in endorsement of 11 DSM-IV alcohol use disorder (AUD) criteria in young adults with persistent or recurrent AUD in The Collaborative Study on the Genetics of Alcoholism
AU - The Collaborative Study on the Genetics of Alcoholism (COGA)
AU - Schuckit, Marc A.
AU - Smith, Tom L.
AU - Danko, George
AU - Tear, Jake
AU - Hennies, Jessica
AU - Mendoza, Lee Anne
AU - Hesselbrock, Victor
AU - Edenberg, Howard J.
AU - Hesselbrock, Michie
AU - Bucholz, Kathleen
AU - Chan, Grace
AU - Kuperman, Samuel
AU - Francis, Meredith W.
AU - Plawecki, Martin H.
AU - Porjesz, B.
AU - Hesselbrock, V.
AU - Foroud, T.
AU - Agrawal, A.
AU - Dick, D.
AU - Edenberg, H. J.
AU - Liu, Y.
AU - Plawecki, M.
AU - Kuperman, S.
AU - Kramer, J.
AU - Meyers, J.
AU - Kamarajan, C.
AU - Pandey, A.
AU - Bierut, L.
AU - Rice, J.
AU - Schuckit, M.
AU - Tischfield, J.
AU - Hart, R.
AU - Salvatore, J.
AU - Almasy, L.
AU - Goate, A.
AU - Slesinger, P.
AU - Scott, D.
AU - Nurnberger, J.
AU - Wetherill, L.
AU - Xuei, X.
AU - Lai, D.
AU - O’Connor, S.
AU - Chan, G.
AU - Chorlian, D. B.
AU - Zhang, J.
AU - Barr, P.
AU - Kinreich, S.
AU - Pandey, G.
AU - Mullins, N.
AU - Anokhin, A.
N1 - Funding Information: The Collaborative Study on the Genetics of Alcoholism (COGA), Principal Investigators: B. Porjesz, V. Hesselbrock, T. Foroud; Scientific Director, A. Agrawal; Translational Director, D. Dick, includes eleven different centers: University of Connecticut (V. Hesselbrock); Indiana University (H. J. Edenberg, T. Foroud, Y. Liu, M. Plawecki); University of Iowa Carver College of Medicine (S. Kuperman, J. Kramer); SUNY Downstate Health Sciences University (B. Porjesz, J. Meyers, C. Kamarajan, A. Pandey); Washington University in St. Louis (L. Bierut, J. Rice, K. Bucholz, A. Agrawal); University of California at San Diego (M. Schuckit); Rutgers University (J. Tischfield, D. Dick, R. Hart, J. Salvatore); The Children's Hospital of Philadelphia, University of Pennsylvania (L. Almasy); Virginia Commonwealth University; Icahn School of Medicine at Mount Sinai (A. Goate, P. Slesinger); and Howard University (D. Scott). Other COGA collaborators include: L. Bauer (University of Connecticut); J. Nurnberger Jr., L. Wetherill, X. Xuei, D. Lai, S. O'Connor, (Indiana University); G. Chan (University of Iowa; University of Connecticut); D. B. Chorlian, J. Zhang, P. Barr, S. Kinreich, G. Pandey (SUNY Downstate); N. Mullins (Icahn School of Medicine at Mount Sinai); A. Anokhin, S. Hartz, E. Johnson, V. McCutcheon, S. Saccone (Washington University); J. Moore, F. Aliev, Z. Pang, S. Kuo (Rutgers University); A. Merikangas (The Children's Hospital of Philadelphia and University of Pennsylvania); H. Chin and A. Parsian are the NIAAA Staff Collaborators. We continue to be inspired by our memories of Henri Begleiter and Theodore Reich, founding PI and Co‐PI of COGA, and also owe a debt of gratitude to other past organizers of COGA, including Ting‐Kai Li, P. Michael Conneally, Raymond Crowe, and Wendy Reich, for their critical contributions. This national collaborative study is supported by NIH Grant U10AA008401 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA). Funding Information: The Collaborative Study on the Genetics of Alcoholism (COGA), Principal Investigators: B. Porjesz, V. Hesselbrock, T. Foroud; Scientific Director, A. Agrawal; Translational Director, D. Dick, includes eleven different centers: University of Connecticut (V. Hesselbrock); Indiana University (H. J. Edenberg, T. Foroud, Y. Liu, M. Plawecki); University of Iowa Carver College of Medicine (S. Kuperman, J. Kramer); SUNY Downstate Health Sciences University (B. Porjesz, J. Meyers, C. Kamarajan, A. Pandey); Washington University in St. Louis (L. Bierut, J. Rice, K. Bucholz, A. Agrawal); University of California at San Diego (M. Schuckit); Rutgers University (J. Tischfield, D. Dick, R. Hart, J. Salvatore); The Children's Hospital of Philadelphia, University of Pennsylvania (L. Almasy); Virginia Commonwealth University; Icahn School of Medicine at Mount Sinai (A. Goate, P. Slesinger); and Howard University (D. Scott). Other COGA collaborators include: L. Bauer (University of Connecticut); J. Nurnberger Jr., L. Wetherill, X. Xuei, D. Lai, S. O'Connor, (Indiana University); G. Chan (University of Iowa; University of Connecticut); D. B. Chorlian, J. Zhang, P. Barr, S. Kinreich, G. Pandey (SUNY Downstate); N. Mullins (Icahn School of Medicine at Mount Sinai); A. Anokhin, S. Hartz, E. Johnson, V. McCutcheon, S. Saccone (Washington University); J. Moore, F. Aliev, Z. Pang, S. Kuo (Rutgers University); A. Merikangas (The Children's Hospital of Philadelphia and University of Pennsylvania); H. Chin and A. Parsian are the NIAAA Staff Collaborators. We continue to be inspired by our memories of Henri Begleiter and Theodore Reich, founding PI and Co-PI of COGA, and also owe a debt of gratitude to other past organizers of COGA, including Ting-Kai Li, P. Michael Conneally, Raymond Crowe, and Wendy Reich, for their critical contributions. This national collaborative study is supported by NIH Grant U10AA008401 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA). Criteria in the Diagnostic and Statistical Manuals (DSMs) of the American Psychiatric Association were created to help clinicians make data-based decisions regarding whether treatment is needed for a patient and to find the therapeutic approach with the best asset-to-liability ratio (Goodwin & Guze, 1996; Hasin et al., 2013; Schuckit et al., 1995). Those criteria for a disorder include multiple items that are written in general terms rather than only a few detailed and precise descriptions of the conditions involved (Hasin et al., 2013; Schuckit, 2013; Schuckit & Saunders, 2006). This more generic approach in DSM allows clinicians the flexibility required for the application of diagnostic criteria to patients of different ages, across the sexes, and from different cultural backgrounds. In the field of substance use disorders, this generic approach to diagnostic criteria facilitated the development of a relatively easy-to-remember single set of substance use disorder criteria to be applied across 10 different categories of substances, including alcohol (i.e., individuals with alcohol use disorder [AUD]; Grant et al., 2017; Kendler et al., 2015; Nolen-Hoeksema & Hilt, 2006; Salvatore et al., 2017; Seglem et al., 2016). Rates of item endorsement of specific AUD criteria items have been shown to change with age in older men with AUD (Schuckit & Smith, 2021). The analyses of prospective data presented below evaluate changes over time in diagnostic item endorsement in a large group of men and women in their twenties with persistent or recurrent DSM-IV AUD (American Psychiatric Association, 1994). Regarding age, as originally predicted by Jellinek (1952), retrospective comparisons across older and younger individuals with AUD demonstrated different ages of onset for different alcohol-related problems (e.g., Schuckit et al., 1993, 1995). These studies indicated higher levels of endorsement of tolerance to alcohol and of using alcohol in hazardous situations in younger versus older drinkers, and higher rates of experiencing alcohol withdrawal syndromes in older versus younger individuals with alcohol problems (Buu et al., 2012; Harford et al., 2005; Marmet et al., 2019). However, most such studies were retrospective and compared younger individuals with older individuals, while only a few papers have reported data from prospective follow-ups that documented changes in problem patterns over time in the same individuals (Jacob et al., 2009; Sloan et al., 2011; Verges et al., 2021). Regarding differences in problem endorsement across the sexes, men are more likely than women to report experiencing withdrawal symptoms (Deshmukh et al., 2003), but women might have higher rates of some alcohol-related physiological and psychological problems (Ceylan-Isik et al., 2010; Edens et al., 2008; Grant et al., 2017; Karastergiou et al., 2012; Mann et al., 1992; Schuckit et al., 2016). In addition, women metabolize alcohol more slowly, have higher blood alcohol concentrations (BACs) per drink, are more sensitive to the effects of alcohol per drink, and are likely to have fewer years between the onset of heavier drinking and entering treatment (Eng et al., 2005; Kapoor et al., 2017; Schuckit et al., 2019). Despite those differences, the outcomes of AUD following treatment in the two sexes appear to be similar (Green et al., 2002; Timko et al., 2002). Regarding sex or gender, most studies cited in this literature review did not distinguish between biological sex (male or female) and gender roles (men or women) but rather relied on whether a person listed themselves as a man or a woman. Therefore, in this review and in the original data described below, we use the terms man or woman generically throughout the manuscript without precision related to biological sex or gender roles. To help expand our understanding of differences in endorsement of different problems with age and across men and women, our group recently published within-subjects prospective data regarding changes in rates of endorsement of specific AUD criteria in individuals with persistent or recurrent AUD (Schuckit & Smith, 2021). These data were extracted from every 5-year prospective evaluation of two generations of participants in the San Diego Prospective Study. That protocol began in 1978 with 453 drinking men who did not meet AUD criteria at an average age of about 20 and who were followed with personal interviews every 5 years up to an average age of about 60 (e.g., Schuckit & Smith, 2021). Follow-up data revealed 106 men who fulfilled AUD criteria during at least three of the 5-year periods between the average ages of 31 and 43. Consistent with DSM-IV guidelines, the diagnosis of dependence required endorsing problems associated with three or more of up to seven areas of life as described below. In the absence of dependence, abuse required endorsement of one or more of the four repetitive abuse items to the point of life impairment (American Psychiatric Association, 1994). In that study, during the thirties to early forties, significant decreases over time were reported for tolerance (DSM-IV dependence item 1, or D1), withdrawal (D2), alcohol-related failure to meet obligations (abuse item 1, or A1), and use of alcohol in hazardous situations (A2). During that same period, these men reported increases over time in endorsement of drinking higher amounts or for longer periods than intended (D3), spending a great deal of time involved with alcohol (D5), and continuing to use alcohol despite social or interpersonal problems (A4). Rates of endorsement did not change significantly over time for criteria related to an inability to stop or control alcohol intake (D4), giving up activities related to alcohol (D6), continuing to use alcohol despite physical or psychological problems (D7), or repetitive legal problems related to drinking (A3). In the San Diego study protocol no data were available on the one criterion found in DSM-5 but not DSM-IV, craving, and, thus, this criterion could not be tested in those analyses (Hasin et al., 2013). San Diego Prospective Study data were also available from a small sample of 68 offspring (71% men) of probands who fulfilled the criteria for an AUD during at least two evaluations between the average ages of 21 and 27 (Schuckit & Smith, 2021). The small sample size and availability of only two follow-up data points contributed to lower statistical power for the analyses in this younger generation. Despite that limitation, during their twenties, the offspring with persistent or recurrent AUDs demonstrated statistically significant increased rates of endorsement for criterion D5 (spending much time regarding alcohol) and D6 (giving up activities because of alcohol). Nonsignificant patterns were also seen for decreases from 54.4% to 41.2% over time for endorsement of tolerance (D1) (p = 0.12) and increases from 19.1% to 29.4% in impaired ability to decrease or control drinking (D4) (p = 0.15). Rates of endorsement did not change significantly for any abuse item for these participants. The relatively small sample hindered comparisons of changes in item endorsement over time across the sexes. The primary goal of the current analyses was to evaluate prospectively measured levels of endorsement of specific AUD criteria early in the course of persistent or recurrent AUD in a relatively large sample of men and women. To accomplish this, we evaluated changes in endorsement of DSM-IV AUD criteria items across three timepoints during their twenties for 377 (59.1% men) Collaborative Study on the Genetics of Alcoholism (COGA) Prospective Study participants. The analyses tested four hypotheses. Hypothesis 1 predicted that the data will demonstrate significant increases over time in the two dependent items that increased significantly in the smaller sample of San Diego offspring: namely criteria D5 (spending a great deal of time regarding alcohol) and D6 (giving up important activities because of alcohol). The second hypothesis was that, in their twenties, the pattern of endorsement of the DSM-IV abuse items will not change significantly over time. Third, we predicted that in the current larger sample with three timepoints, these COGA Prospective Study subjects will demonstrate significant changes in endorsement of the two criteria with the most robust nonsignificant levels of change in the smaller San Diego sample, namely increases in impaired ability to decrease or control of drinking (D4) and decreases in endorsement of tolerance (D1). Fourth, based on findings from an earlier retrospective study of similar ages of onset of alcohol problems in men and women (Schuckit et al., 1995), Hypothesis 4 predicted that similar changes in endorsement of DSM criteria items will be seen for men and women. Information on AUD-item endorsement over time was available for 223 men and 154 women aged 20-25 with persistent or recurrent AUD in at least three interviews in the Collaborative Study on the Genetics of Alcoholism. The statistical significance of endorsement changes over time was evaluated using the related-sample Cochran's Q test for the full sample and for men and women separately. Additional analyses evaluated sex differences in the patterns of change. Publisher Copyright: © 2023 Research Society on Alcohol.
PY - 2023/5
Y1 - 2023/5
N2 - Background: Endorsement of specific Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) alcohol use disorder (AUD) criteria have been shown to change significantly over time in men in their thirties who have persistent or recurrent AUD. However, few studies have documented whether the endorsement of AUD items changes over time in younger individuals or in women. We evaluated changes in the endorsement of AUD criteria in 377 men and women with persistent or recurrent AUD during their twenties. Methods: Information on AUD-item endorsement over time was available for 223 men and 154 women aged 20-25 with persistent or recurrent AUD in at least three interviews in the Collaborative Study on the Genetics of Alcoholism. The statistical significance of endorsement changes over time was evaluated using the related-sample Cochran's Q test for the full sample and for men and women separately. Additional analyses evaluated sex differences in the patterns of change. Results: In the full sample, the predominant pattern was for a significant increase in the rates of endorsement for six of the seven alcohol dependence criteria but not in the four abuse criteria. A similar pattern was seen within men, but women had significant changes in only three of the seven dependence criteria. Conclusions: Endorsement of the seven alcohol dependence criteria among individuals with persistent or recurrent AUD in their twenties generally increased, but few changes were observed in the rates of endorsement of the four abuse criteria. These results are discussed in terms of how they reflect on the nature of AUD and the DSM criteria.
AB - Background: Endorsement of specific Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) alcohol use disorder (AUD) criteria have been shown to change significantly over time in men in their thirties who have persistent or recurrent AUD. However, few studies have documented whether the endorsement of AUD items changes over time in younger individuals or in women. We evaluated changes in the endorsement of AUD criteria in 377 men and women with persistent or recurrent AUD during their twenties. Methods: Information on AUD-item endorsement over time was available for 223 men and 154 women aged 20-25 with persistent or recurrent AUD in at least three interviews in the Collaborative Study on the Genetics of Alcoholism. The statistical significance of endorsement changes over time was evaluated using the related-sample Cochran's Q test for the full sample and for men and women separately. Additional analyses evaluated sex differences in the patterns of change. Results: In the full sample, the predominant pattern was for a significant increase in the rates of endorsement for six of the seven alcohol dependence criteria but not in the four abuse criteria. A similar pattern was seen within men, but women had significant changes in only three of the seven dependence criteria. Conclusions: Endorsement of the seven alcohol dependence criteria among individuals with persistent or recurrent AUD in their twenties generally increased, but few changes were observed in the rates of endorsement of the four abuse criteria. These results are discussed in terms of how they reflect on the nature of AUD and the DSM criteria.
KW - alcoholism
KW - diagnosis
KW - longitudinal
UR - http://www.scopus.com/inward/record.url?scp=85151089342&partnerID=8YFLogxK
U2 - 10.1111/acer.15054
DO - 10.1111/acer.15054
M3 - Article
C2 - 36924463
AN - SCOPUS:85151089342
SN - 0145-6008
VL - 47
SP - 919
EP - 929
JO - Alcoholism: Clinical and Experimental Research
JF - Alcoholism: Clinical and Experimental Research
IS - 5
ER -