Investigating the appropriateness of current alcohol-use disorder criteria for adolescents

  • The same alcohol-use disorder criteria are currently used for both adults and adolescents, despite concerns about the appropriateness of these criteria for adolescents.
  • New findings suggest that "tolerance" and "time spent" using/obtaining/recovering from alcohol may be over-diagnosed in adolescents.

North American clinicians generally use alcohol-use disorder (AUD) criteria as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Concerns exist, however, about the appropriateness of these criteria for adolescents. For the first time, a study in the May issue of Alcoholism: Clinical & Experimental Research uses a single representative sample of the U.S. population to examine the effects of age, gender, race/ethnicity, and drinking status on the prevalence of DSM-IV diagnostic criteria among both adolescents and adults.

"DSM-IV criteria were developed with clinical adult populations," said Thomas C. Harford, a senior research analyst with CSR, Incorporated and first author of the study. "However, when compared to adults, drinking among adolescents is relatively infrequent and drinking histories tend to have shorter durations. Consequently, many symptoms such as withdrawal and alcohol-related medical complications are not typically experienced by adolescents."

"Recent research with adolescent clinical and community samples has identified important limitations of DSM-IV criteria when applied to adolescents," added Christopher Martin, associate professor of psychiatry and psychology at the University of Pittsburgh School of Medicine. "These include, one, that the dependence symptoms of tolerance, 'much time spent' using, and using more/longer than intended appear to often be over diagnosed in adolescent studies; two, that the ways in which these dependence criteria are measured has a huge downstream impact on the estimated prevalence of abuse and dependence diagnoses; an


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