The Alcohol Dependence Scale and DSM-5 Alcohol Use Disorder: Severity ratings correspond insufficiently in older patients

Anna Mejldal*, Kjeld Andersen, Randi Bilberg, Barbara Braun, Michael P Bogenschutz, Gerhard Bühringer, Anette Søgaard Nielsen, Silke Behrendt

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

Objectives: To investigate the psychometric properties of the frequently used Alcohol Dependence Scale (ADS) in older adults and the associations between ADS scores and alcohol use and DSM-5 AUD symptom counts. Methods: Using baseline data from an international multicenter RCT on outpatient AUD treatment for adults aged 60+ with DSM-5 alcohol use disorder (AUD; n = 529), we computed Cronbach's alpha (α) and applied confirmatory (CFA) and exploratory factor analysis (EFA) to determine the underlying factor structure. A structural equation model (SEM) explored the interrelationship of latent ADS factors with alcohol use and number of DSM-5 criteria endorsed. Results: Internal consistency of the ADS (α = 0.81) was good. EFA revealed a three-factor structure. Factor 1 (“Severe withdrawal symptoms”) consisted of severe psychoperceptual and psychophysical consequences of excessive drinking, Factor 2 (“Loss of control”) consisted of acute physical reactions of intoxication, and Factor 3 (“Obsessive–compulsive drinking”) described habitual drinking. The SEM suggested that only Factor 3 had large effects on DSM-5 symptom score and drinking behavior. Conclusion: Lowering the ADS threshold or focusing on ADS items from Factor 3 may be more suitable measures of severity of alcohol dependence in treatment-seeking older adults as ADS scores are low and not closely related to DSM-5 AUD.

Original languageEnglish
Article numbere1811
JournalInternational Journal of Methods in Psychiatric Research (Print)
Volume29
Issue number1
Number of pages11
ISSN1049-8931
DOIs
Publication statusPublished - Mar 2020

Keywords

  • alcohol dependence
  • assessment
  • diagnosis
  • older adults
  • severity

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