TY - JOUR
T1 - Diagnostic Criteria for Identifying Individuals at High Risk of Progression From Mild or Moderate to Severe Alcohol Use Disorder
AU - Miller, Alex P.
AU - Kuo, Sally I.Chun
AU - Johnson, Emma C.
AU - Tillman, Rebecca
AU - Brislin, Sarah J.
AU - Dick, Danielle M.
AU - Kamarajan, Chella
AU - Kinreich, Sivan
AU - Kramer, John
AU - McCutcheon, Vivia V.
AU - Plawecki, Martin H.
AU - Porjesz, Bernice
AU - Schuckit, Marc A.
AU - Salvatore, Jessica E.
AU - Edenberg, Howard J.
AU - Bucholz, Kathleen K.
AU - Meyers, Jaquelyn L.
AU - Agrawal, Arpana
N1 - Publisher Copyright:
© 2023 Miller AP et al. JAMA Network Open.
PY - 2023/10/2
Y1 - 2023/10/2
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85175742215&partnerID=8YFLogxK
U2 - 10.1001/jamanetworkopen.2023.37192
DO - 10.1001/jamanetworkopen.2023.37192
M3 - Article
C2 - 37815828
AN - SCOPUS:85175742215
SN - 2574-3805
SP - E2337192
JO - JAMA Network Open
JF - JAMA Network Open
ER -