Saha Tulshi D, Chou S Patricia, Grant Bridget F
Laboratory of Biometry and Epidemiology, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institute of Health, Department of Health and Human Services, Bethesda, MD 20892-9304, USA.
Psychol Med. 2006 Jul;36(7):931-41. doi: 10.1017/S003329170600746X. Epub 2006 Mar 27.
Item response theory (IRT) was used to determine whether the DSM-IV diagnostic criteria for alcohol abuse and dependence are arrayed along a continuum of severity.
Data came from a large nationally representative sample of the US population, 18 years and older. A two-parameter logistic IRT model was used to determine the severity and discrimination of each DSM-IV criterion. Differential criterion functioning (DCF) was also assessed across subgroups of the population defined by sex, age and race-ethnicity.
All DSM-IV alcohol abuse and dependence criteria, except alcohol-related legal problems, formed a continuum of alcohol use disorder severity. Abuse and dependence criteria did not consistently tap the mildest or more severe end of the continuum respectively, and several criteria were identified as potentially redundant. The drinking in larger amounts or for longer than intended dependence criterion had the greatest discrimination and lowest severity than any other criterion. Although several criteria were found to function differentially between subgroups defined in terms of sex and age, there was evidence that the generalizability and validity of the criterion forming the continuum remained intact at the test score level.
DSM-IV diagnostic criteria for alcohol abuse and dependence form a continuum of severity, calling into question the abuse-dependence distinction in the DSM-IV and the interpretation of abuse as a milder disorder than dependence. The criteria tapped the more severe end of the alcohol use disorder continuum, highlighting the need to identify other criteria capturing the mild to intermediate range of the severity. The drinking larger amounts or longer than intended dependence criterion may be a bridging criterion between drinking patterns that incur risk of alcohol use disorder at the milder end of the continuum, with tolerance, withdrawal, impaired control and serious social and occupational dysfunction at the more severe end of the alcohol use disorder continuum. Future IRT and other dimensional analyses hold great promise in informing revisions to categorical classifications and constructing new dimensional classifications of alcohol use disorders based on the DSM and the ICD.
采用项目反应理论（IRT）来确定《精神疾病诊断与统计手册》第四版（DSM-IV）中酒精滥用和酒精依赖的诊断标准是否沿严重程度连续分布。
数据来自美国18岁及以上具有全国代表性的大样本。采用双参数逻辑IRT模型来确定每个DSM-IV标准的严重程度和区分度。还评估了按性别、年龄和种族划分的人群亚组间的标准差异功能（DCF）。
除与酒精相关的法律问题外，所有DSM-IV酒精滥用和酒精依赖标准构成了酒精使用障碍严重程度的连续分布。滥用和依赖标准并非始终分别针对连续分布的最轻微或最严重一端，并且有几个标准被确定为可能冗余。“饮酒量比预期大或时间比预期长”这一依赖标准比其他任何标准具有更大的区分度和最低的严重程度。尽管发现几个标准在按性别和年龄定义的亚组间存在差异功能，但有证据表明，构成连续分布的标准在测验分数水平上的可推广性和有效性保持不变。
DSM-IV中酒精滥用和酒精依赖的诊断标准构成了严重程度的连续分布，这对DSM-IV中滥用与依赖的区分以及将滥用解释为比依赖程度较轻的障碍提出了质疑。这些标准针对的是酒精使用障碍连续分布的较严重一端，凸显了识别其他涵盖严重程度轻度至中度范围的标准的必要性。“饮酒量比预期大或时间比预期长”这一依赖标准可能是一个桥梁标准，它连接了在连续分布较轻一端引发酒精使用障碍风险的饮酒模式与在酒精使用障碍连续分布较严重一端出现耐受性、戒断反应、控制受损以及严重社会和职业功能障碍的饮酒模式。未来的IRT和其他维度分析在为类别分类的修订提供信息以及基于DSM和ICD构建酒精使用障碍的新维度分类方面具有巨大潜力。
