Hasin D, Grant B
New York State Psychiatric Institute, New York 10032.
Alcohol Clin Exp Res. 1994 Dec;18(6):1348-53. doi: 10.1111/j.1530-0277.1994.tb01435.x.
In 1994, DSM-IV will be published, with new criteria for alcohol abuse and dependence. Implications of the changes in criteria for alcohol use disorders were investigated by comparing the diagnoses made by the DSM-IV criteria and DSM-III-R criteria. The study was conducted in a sample of 424 patients in an inpatient alcohol rehabilitation unit in the New York metropolitan area. DSM-III-R and DSM-IV criteria showed similar results and high agreement for any alcohol use disorder (abuse and dependence combined). Alcohol dependence was also consistently diagnosed with DSM-III-R and DSM-IV criteria. Agreement between DSM-III-R and DSM-IV abuse diagnoses was very low. Compared with DSM-III-R, DSM-IV classified over three times as many patients as alcohol abusers, although those with alcohol dependence still overwhelmingly dominated the sample. With some fluctuations, the results were stable over Black, Hispanic, and White subgroups of patients. The direction of the findings was consistent with results from a national general population survey in that the prevalence of alcohol abuse increased in both studies. However, the clinical results alone would not have suggested the marked changes in relative prevalence of abuse and dependence that occurred in the general population when DSM-IV criteria were used in place of DSM-III-R. Research on diagnostic criteria limited to patient samples omits important information on the implications of changing aspects of the diagnostic criteria. The need for a coherent theory of alcohol abuse is highlighted.
1994年，《精神疾病诊断与统计手册》第四版（DSM-IV）将出版，其中包含酒精滥用和酒精依赖的新诊断标准。通过比较依据DSM-IV标准和DSM-III-R标准所做出的诊断，对酒精使用障碍诊断标准变化的影响进行了调查研究。该研究以纽约大都市地区一家住院酒精康复机构的424名患者为样本展开。DSM-III-R和DSM-IV标准对于任何酒精使用障碍（滥用和依赖合并）显示出相似的结果和高度一致性。酒精依赖在DSM-III-R和DSM-IV标准下也始终能得到一致的诊断。DSM-III-R和DSM-IV关于酒精滥用的诊断之间的一致性非常低。与DSM-III-R相比，DSM-IV将三倍多的患者归类为酒精滥用者，尽管酒精依赖患者在样本中仍占绝大多数。尽管存在一些波动，但在黑人、西班牙裔和白人亚组患者中结果是稳定的。研究结果的趋势与一项全国普通人群调查的结果一致，即在两项研究中酒精滥用的患病率均有所上升。然而，仅从临床结果本身并不能看出当使用DSM-IV标准取代DSM-III-R标准时，普通人群中滥用和依赖的相对患病率发生了显著变化。局限于患者样本的诊断标准研究遗漏了关于诊断标准变化影响的重要信息。这凸显了建立连贯的酒精滥用理论的必要性。
