Evaluating the validity and utility of scaling alcohol consumption indices alongside AUD symptoms in treatment-seeking adolescents

Diagnostic validity of drinking behaviour for identifying alcohol use disorder: Findings from a representative sample of community adults and an inpatient clinical sample

BACKGROUND AND AIMS

Alcohol consumption is an inherent feature of alcohol use disorder (AUD), and drinking patterns may be diagnostically informative. This study had three aims: (1) to examine the classification accuracy of several individually analysed drinking behavior measures in a large sample of US community adults; (2) to extend the findings to an adult clinical sample; and (3) to examine potential sex differences.

DESIGN

In cross-sectional epidemiological and clinical datasets, receiver operating characteristic (ROC) curves were used to evaluate diagnostic classification using area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

SETTING AND PARTICIPANTS

Two samples were examined: a large random sample of US community adults who reported past-year drinking (n = 25 773, AUD = 20%) and a clinical sample from a Canadian inpatient addiction treatment centre (n = 1341, AUD = 82%).

MEASUREMENTS

Classifiers included measures of quantity/frequency (e.g. drinks/drinking day, largest drinks/drinking day, number of drinking days and heavy drinking frequency). The clinical criterion (reference standard) was AUD diagnostic status per structured clinical interview (community sample) or a symptom checklist (clinical sample).

FINDINGS

All drinking indicators were statistically significant classifiers of AUD (AUCs = 0.60-0.92, Ps<0.0001). Heavy drinking frequency indicators performed optimally in both the community (AUCs = 0.78-0.87; accuracy = 0.72-0.80) and clinical (AUCs = 0.85-0.92; accuracy = 0.77-0.89) samples. Collectively, the most discriminating drinking behaviours were number of heavy drinking episodes and frequency of exceeding drinking low-risk guidelines. No substantive sex differences were observed across drinking metrics.

CONCLUSIONS

Quantitative drinking indices appear to perform well at classifying alcohol use disorder (AUD) in both a large community adult and inpatient sample, robustly identifying AUD at rates much better than chance and above accepted clinical classification benchmarks, with limited differences by sex. These findings broadly support the potential clinical utility of quantitative drinking indicators in routine patient assessment.

Predictors of symptom course in alcohol use disorder

BACKGROUND

Symptoms often play an important role in the scientific inquiry of psychological disorders and have been theorized to play a functional role in the disorders themselves. However, little is known about the course of specific symptoms and individual differences in course. Understanding the course of specific symptoms and factors influencing symptom course can inform psychological theory and future research on course and treatment.

METHODS

The current study examined alcohol use disorder (AUD) criteria to explore how etiologically relevant covariates differentially affected the course of individual criteria. The study examined 34,653 participants from Wave 1 (2001-2002) and Wave 2 (2003-2004) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), to analyze the extent to which AUD symptom course is predicted by alcohol consumption patterns, family history of alcoholism, the presence of internalizing and externalizing disorders, and race.

RESULTS

The course of all AUD criteria was significantly influenced by these predictors, with the magnitude of the influence varying across different criteria and different aspects of the course (i.e., onset, persistence, recurrence). The strength of the relationship is partially related to the theoretical proximity of a given covariate to AUD symptomatology, with heavy drinking being the strongest and family history of AUD being the weakest. The course of all criteria was strongly associated with the prevalence of the criterion in the overall sample.

CONCLUSIONS

The course of AUD criteria is heterogeneous, appearing to be influenced by conceptually proximal predictors, the prevalence of the criterion, and perhaps an underlying common factor. Diagnostic accuracy may be improved by including a criterion related to alcohol consumption. Future work should include exploring the interchangeability of criteria and alternative operationalization of them.

The information capacity of adolescent alcohol consumption indicators along a continuum of severity: A cross-national comparison of sixteen Central and Eastern European countries

BACKGROUND

There is high variability between European countries in prevalence levels of various alcohol consumption forms. The informational value of adolescent's alcohol consumption indicators remains an issue. The present study aimed to examine information capacity and measurement invariance of different alcohol consumption indicators in adolescents coming from countries of the former Soviet (Eastern) Bloc in Central and Eastern Europe (CEE).

METHODS

Data of 15-year-old adolescents who reported to have had consumed alcohol at least once in their lifetime were analysed. Data were collected in sixteen CEE countries, as part of the 2013/2014 Health Behavior in School-aged Children (HBSC) study wave. Four binary items were selected for the analyses and measured the presence (vs. absence) of alcohol consumption in the last 30 days, lifetime drunkenness, weekly drinking frequency and binge drinking on a typical occasion. Multiple group confirmatory factor analysis and item response theory analysis were used.

RESULTS

In most of the included countries, alcohol consumption in the last 30 days and lifetime drunkenness were indicative for lower severity levels, while binge drinking and weekly drinking frequency were informative at higher severity levels of alcohol use. A low proportion of the estimated intercepts and factor loadings were non-invariant which indicated approximate cross-national invariance of these indicators.

CONCLUSIONS

Adolescent alcohol consumption indicators are informative for different severity levels and provide a cross-nationally invariant measurement. However, diverging drinking cultures in the CEE regions was suggested by different indicators with the highest discrimination capacity at the lower and the higher ends of the continuum severity.