Document Detail

Toward the DSM-V: the Withdrawal-Gate Model versus the DSM-IV in the diagnosis of alcohol abuse and dependence.
MedLine Citation:
PMID:  11068966     Owner:  NLM     Status:  MEDLINE    
The Diagtnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) classifies as dependent many cases of mild alcohol problems. DSM-IV diagnoses have modest relationships with predictive and some concurrent validators and often improperly sequence the onset of abuse versus dependence, perhaps due to insufficient emphasis on physiological features. Testing reliability, syndrome prevalence, syndrome sequencing, and concurrent and predictive validity, this study contrasted the DSM-IV with the Withdrawal-Gate Model (WGM), in which alcohol withdrawal is necessary and sufficient for the dependence diagnosis. Clinical samples of adults (baseline n = 318) and adolescents (baseline n = 214) meeting abuse or dependence were assessed for DSM-IV alcohol symptoms and external measures of problem severity and reinterviewed at 6 (adults) and 12 months (adults and adolescents). Among DSM-IV dependent cases, the WGM shifted 32% of adults and 80% of adolescents to the abuse category, making both categories more symptomatically severe, but had a negligible effect on the prevalence of total alcohol diagnoses. The WGM was more reliable than the DSM-IV and temporally sequenced abuse before dependence in a greater number of cases. The WGM was superior to the DSM-IV in concurrent and predictive validity on most measures. Future diagnostic systems may be more reliable and valid if they require evidence of withdrawal for substance dependence.
J Langenbucher; C S Martin; E Labouvie; P M Sanjuan; L Bavly; N K Pollock
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of consulting and clinical psychology     Volume:  68     ISSN:  0022-006X     ISO Abbreviation:  J Consult Clin Psychol     Publication Date:  2000 Oct 
Date Detail:
Created Date:  2000-11-29     Completed Date:  2000-11-29     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0136553     Medline TA:  J Consult Clin Psychol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  799-809     Citation Subset:  IM    
Center of Alcohol Studies, Rutgers University, Piscataway, New Jersey 08855-8001, USA.
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MeSH Terms
Alcohol Drinking / physiopathology,  psychology
Alcohol Withdrawal Delirium / diagnosis
Alcoholism / classification,  diagnosis*,  physiopathology,  psychology
Diagnosis, Differential
Models, Psychological
Predictive Value of Tests
Psychiatric Status Rating Scales / standards*
Reproducibility of Results
Severity of Illness Index
Grant Support

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