Hasin D, Li Q, Mccloud S, Endicott J
Columbia University and New York State Psychiatric Institute 10032, USA.
Addiction. 1996 Oct;91(10):1517-27. doi: 10.1046/j.1360-0443.1996.9110151710.x.
DSM-III-R, DSM-IV and ICD-10 definitions of alcohol dependence were all developed from the concept of the Alcohol Dependence Syndrome, and thus have a common theoretical link. This link is not shared by DSM-III, and no link exists between definitions of abuse in the different classification systems. The level of agreement on diagnoses produced by the different systems has practical as well as theoretical implications. We tested this agreement in 962 US household residents randomly sampled and screened for heavier than average drinking in the last 12 months. Agreement for most comparisons involving diagnoses of current dependence ranged from good to excellent, with no clear pattern of lower agreement for DSM-III. However, agreement on past dependence was sharply lower for comparisons involving DSM-III than those involving the other classification systems. This appeared to be due to the DSM-III requirement for physiological dependence and the apparently emerging nature of the disorder in this relatively young, non-treatment sample. Comparisons for abuse were generally poor for current as well as past diagnoses. Implications of the findings are discussed.
《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）、《精神疾病诊断与统计手册》第四版（DSM-IV）以及国际疾病分类第十版（ICD-10）中对酒精依赖的定义均源自酒精依赖综合征的概念，因此存在共同的理论联系。而《精神疾病诊断与统计手册》第三版（DSM-III）不存在这种联系，不同分类系统中对滥用的定义之间也没有关联。不同系统所做出诊断的一致程度具有实际意义和理论意义。我们对962名美国家庭居民进行了测试，这些居民是从过去12个月中饮酒量高于平均水平的人群中随机抽样筛选出来的。大多数涉及当前依赖诊断的比较的一致性从良好到优秀不等，对于DSM-III，没有明显的较低一致性模式。然而，与涉及其他分类系统的比较相比，涉及DSM-III的过去依赖诊断的一致性明显更低。这似乎是由于DSM-III对生理依赖的要求以及在这个相对年轻的、未经治疗的样本中该疾病明显的新发性质。对于当前和过去的滥用诊断，比较结果总体较差。本文讨论了这些研究结果的意义。
