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- Title
Diagnostic Criteria for Identifying Individuals at High Risk of Progression From Mild or Moderate to Severe Alcohol Use Disorder.
- Authors
Miller, Alex P.; Kuo, Sally I-Chun; Johnson, Emma C.; Tillman, Rebecca; Brislin, Sarah J.; Dick, Danielle M.; Kamarajan, Chella; Kinreich, Sivan; Kramer, John; McCutcheon, Vivia V.; Plawecki, Martin H.; Porjesz, Bernice; Schuckit, Marc A.; Salvatore, Jessica E.; Edenberg, Howard J.; Bucholz, Kathleen K.; Meyers, Jaquelyn L.; Agrawal, Arpana
- Abstract
This cohort study examines data from the Collaborative Study on the Genetics of Alcoholism to assess whether specific diagnostic criteria for alcohol use disorder that are indicative of greater severity could help detect a greater likelihood of progression. Key Points: Question: Does emphasis on specific criteria for alcohol use disorder (AUD) improve the identification of individuals at risk for developing more severe AUD? Findings: In this cohort study, cross-sectional and longitudinal multimodal secondary analyses involving a combined 15 928 individuals indicated that endorsement of criteria empirically designated as representing greater severity of AUD was significantly associated with 2-fold increased likelihood of progression from mild-to-moderate AUD to severe AUD, even after accounting for total criterion count. Meaning: Emphasis on more severe criteria as indicators of vulnerability for severe AUD in current diagnostic approaches may increase detection of individuals with greater likelihood for disorder progression. Importance: Current Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) diagnoses of substance use disorders rely on criterion count–based approaches, disregarding severity grading indexed by individual criteria. Objective: To examine correlates of alcohol use disorder (AUD) across count-based severity groups (ie, mild, moderate, mild-to-moderate, severe), identify specific diagnostic criteria indicative of greater severity, and evaluate whether specific criteria within mild-to-moderate AUD differentiate across relevant correlates and manifest in greater hazards of severe AUD development. Design, Setting, and Participants: This cohort study involved 2 cohorts from the family-based Collaborative Study on the Genetics of Alcoholism (COGA) with 7 sites across the United States: cross-sectional (assessed 1991-2005) and longitudinal (assessed 2004-2019). Statistical analyses were conducted from December 2022 to June 2023. Main Outcomes and Measures: Sociodemographic, alcohol-related, psychiatric comorbidity, brain electroencephalography (EEG), and AUD polygenic score measures as correlates of DSM-5 AUD levels (ie, mild, moderate, severe) and criterion severity–defined mild-to-moderate AUD diagnostic groups (ie, low-risk vs high-risk mild-to-moderate). Results: A total of 13 110 individuals from the cross-sectional COGA cohort (mean [SD] age, 37.8 [14.2] years) and 2818 individuals from the longitudinal COGA cohort (mean baseline [SD] age, 16.1 [3.2] years) were included. Associations with alcohol-related, psychiatric, EEG, and AUD polygenic score measures reinforced the role of increasing criterion counts as indexing severity. Yet within mild-to-moderate AUD (2-5 criteria), the presence of specific high-risk criteria (eg, withdrawal) identified a group reporting heavier drinking and greater psychiatric comorbidity even after accounting for criterion count differences. In longitudinal analyses, prior mild-to-moderate AUD characterized by endorsement of at least 1 high-risk criterion was associated with more accelerated progression to severe AUD (adjusted hazard ratio [aHR], 11.62; 95% CI, 7.54-17.92) compared with prior mild-to-moderate AUD without endorsement of high-risk criteria (aHR, 5.64; 95% CI, 3.28-9.70), independent of criterion count. Conclusions and Relevance: In this cohort study of a combined 15 928 individuals, findings suggested that simple count-based AUD diagnostic approaches to estimating severe AUD vulnerability, which ignore heterogeneity among criteria, may be improved by emphasizing specific high-risk criteria. Such emphasis may allow better focus on individuals at the greatest risk and improve understanding of the development of AUD.
- Subjects
UNITED States; DIAGNOSIS of alcoholism; DISEASE progression; RESEARCH; CONFIDENCE intervals; CROSS-sectional method; MANN Whitney U Test; FISHER exact test; SEVERITY of illness index; COMPARATIVE studies; DESCRIPTIVE statistics; RESEARCH funding; CLASSIFICATION of mental disorders; STATISTICAL correlation; DATA analysis software; ODDS ratio; LONGITUDINAL method; PROPORTIONAL hazards models
- Publication
JAMA Network Open, 2023, Vol 6, Issue 10, pe2337192
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.37192