Manual of Mental Disorders Can Help At-Risk Drinkers

The latest Diagnostic and Statistical Manual of Mental Disorders – the DSM-5 -- revises the diagnosis for alcohol use disorder (AUD) with several new criteria for professionals to take into account. Researchers at the Mailman School of Public Health, with colleagues from the Department of Psychiatry at University of São Paulo, Brazil, studied the new benchmarks to determine how they can be applied to target different prevention and treatment strategies. In particular, the new DSM-5-AUD information can help the experts identify risky drinkers and target a larger group of individuals for preventive interventions than they might have reached in the past.
 

Using data from the Sao Paulo Megacity Health Survey (SPMHS), the Brazilian counterpart of the World Mental Health Survey Initiative, the research team, led by Silvia Martins, MD, PhD, associate professor of Epidemiology, studied a sample of 948 individuals who endorsed having one drink per week or more in the past year.  The 948 studied were not required to meet the criteria for alcohol use disorder and thus provided the researchers an opportunity to study general alcohol use among Brazil’s adult population who had at least 1 drink per week in the past year. Sociodemographic characteristics associated with the new alcohol use disorder diagnosis were also considered.

The findings showed there were three distinct classes of past-year alcohol users who drank at least once a week; the vast majority of these alcohol users (nearly 70%) were considered “non-symptomatic” and less than 1% of respondents in this class received a DSM-5 AUD diagnosis. “We found that the two symptomatic classes well represented the dimensionality of the new proposed AUD criteria,” said Dr. Martins. The “use in larger amounts class” reflected the less severe level of this disorder, and captured more than 90% in the DSM-5 AUD category. At the upper end of the spectrum -- the “high-moderate symptomatic class,” represented Severe DSM-5 AUD.

Dr. Martins also reported a higher prevalence of men among past-year alcohol users. Other significant differences were found in age, household income, employment status, and education. For example, lower educational attainment and unemployment status were associated with the “high-moderate symptomatic class, a finding in-line with other recent studies conducted in Brazil. Individuals with high –average household income were less likely to be in the “use in larger amounts” class indicating that higher income has a protective effect for heavy drinking, and alcohol use disorder. With regard to marital quality, Dr. Martins found that drinking in larger amounts was associated with an increase in marriage disruption rates. No link was found between gender and the two problematic alcohol classes, and Dr. Martins suggests this may be a result of the recent trend of increased alcohol use among females in Brazil and worldwide.

“The new DSM-5-AUD criteria has the advantage of shedding light on risky drinkers allowing for preventive and brief interventions, which could reach a large number of individuals. Future studies may distinguish additional patterns among users as well,” said Dr. Martins.

Funding was provided by the State of São Paulo Research Foundation, Brazil (FAPESP Grant 439 03/00204-3. Dr. Martins is also supported by NIH-NICHD  1R01HD060072.

Read the study in Drug and Alcohol Dependence.