Hasin D, Paykin A
Department of Psychiatry, Columbia University College of Physicians and Surgeons, and New York State Psychiatric Institute, New York 10032, USA.
Alcohol Clin Exp Res. 1999 Jan;23(1):144-50.
The Alcohol Dependence Syndrome concept has had a widespread influence on the major nosological classification systems, most recently with its operationalization as DSM-IV alcohol dependence. Although many studies have provided evidence of the validity of the Alcohol Dependence Syndrome in clinical samples, little validation work has been conducted in general population samples on DSM-IV alcohol dependence or the distinction of DSM-IV alcohol dependence from DSM-IV alcohol abuse. We therefore examined the cross-sectional validity of DSM-IV alcohol dependence and abuse in 27,616 household residents who participated in a 1992 national survey on alcohol use disorders. Validity was investigated by testing the association of a set of five "criterion" variables, external to the alcohol diagnostic criteria, with dependence and abuse diagnoses. Results indicated that dependence diagnoses were significantly associated with all criterion variables when compared with those with no diagnosis and also when compared with alcohol abuse. This supported the separation of dependence from abuse. Abuse diagnoses were associated with some, but not all, criterion variables when compared with subjects with no diagnosis. This report replicates many aspects of a similar investigation in a community sample of household residents. Implications for the next steps in research are discussed.
酒精依赖综合征概念对主要的疾病分类系统产生了广泛影响，最近它已被纳入《精神疾病诊断与统计手册》第四版（DSM-IV）的酒精依赖诊断标准之中。尽管许多研究已证实酒精依赖综合征在临床样本中的有效性，但针对普通人群样本中DSM-IV酒精依赖的验证工作以及DSM-IV酒精依赖与DSM-IV酒精滥用的区分，却鲜有开展。因此，我们对参与1992年全国酒精使用障碍调查的27616名家庭居民进行了研究，以检验DSM-IV酒精依赖和滥用的横断面有效性。通过测试一组独立于酒精诊断标准的五个“标准”变量与依赖和滥用诊断之间的关联来研究有效性。结果表明，与未诊断者相比，依赖诊断与所有标准变量均显著相关，与酒精滥用者相比亦是如此。这支持了将依赖与滥用区分开来。与未诊断者相比，滥用诊断与部分而非全部标准变量相关。本报告重复了在家庭居民社区样本中进行的类似调查的许多方面。文中还讨论了对下一步研究的启示。
