Diagnostic Criteria for Identifying Individuals at High Risk of Progression From Mild or Moderate to Severe Alcohol Use Disorder
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Published:2023-10-10
Issue:10
Volume:6
Page:e2337192
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Miller Alex P.1, Kuo Sally I-Chun2, Johnson Emma C.1, Tillman Rebecca1, Brislin Sarah J.2, Dick Danielle M.2, Kamarajan Chella3, Kinreich Sivan3, Kramer John4, McCutcheon Vivia V.1, Plawecki Martin H.5, Porjesz Bernice3, Schuckit Marc A.6, Salvatore Jessica E.2, Edenberg Howard J.7, Bucholz Kathleen K.1, Meyers Jaquelyn L.3, Agrawal Arpana1, Hesselbrock Victor8, Foroud Tatiana8, Liu Yunlong8, Kuperman Samuel8, Pandey Ashwini K.8, Bierut Laura J.8, Rice John8, Tischfield Jay A.8, Hart Ronald P.8, Almasy Laura8, Goate Alison8, Slesinger Paul8, Scott Denise M.8, Bauer Lance O.8, Nurnberger John I.8, Wetherill Leah8, Xuei Xiaoling8, Lai Dongbing8, O'Connor Sean J.8, Chan Grace8, Chorlian David B.8, Zhang Jian8, Barr Peter B.8, Pandey Gayathri8, Mullins Niamh8, Anokhin Andrey P.8, Hartz Sarah8, Saccone Scott8, Moore Jennifer C.8, Aliev Fazil8, Pang Zhiping8, Merikangas Alison8, Chin Hemin8, Parsian Abbas8,
Affiliation:
1. Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri 2. Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey 3. Department of Psychiatry and Behavioral Sciences, State University of New York Health Sciences University, Brooklyn 4. Department of Psychiatry, University of Iowa, Iowa City 5. Department of Psychiatry, Indiana University, Indianapolis 6. Department of Psychiatry, University of California San Diego Medical School, San Diego 7. Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis 8. for the Collaborative Study on the Genetics of Alcoholism (COGA)
Abstract
ImportanceCurrent 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.ObjectiveTo 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 ParticipantsThis 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 MeasuresSociodemographic, 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).ResultsA 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 RelevanceIn 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.
Publisher
American Medical Association (AMA)
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