Abstract
Background
Alcohol withdrawal (AW) is an important clinical and diagnostic feature of alcohol dependence. AW has been found to predict a worsened course of illness in clinical samples, but in some community studies, AW endorsement rates are strikingly high, suggesting false‐positive symptom assignments. Little research has examined the validity of the DSM‐5 algorithm for AW, which requires either the presence of at least 2 of 8 subcriteria (i.e., autonomic hyperactivity, tremulousness, insomnia, nausea, hallucinations, psychomotor agitation, anxiety, and grand mal seizures), or, the use of alcohol to avoid or relieve these symptoms.
Methods
We used item and algorithm analyses of data from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (current drinkers, n = 26,946 at wave 1) to study the validity of DSM‐5 AW as operationalized by the Alcohol Use Disorder and Associated Disabilities Interview Schedule‐DSM‐IV (AUDADIS‐IV).
Results
A substantial proportion of individuals given the AW symptom reported only modest to moderate levels of alcohol use and alcohol problems. Alternative AW algorithms were superior to DSM‐5 in terms of levels of alcohol use and alcohol problem severity among those with AW, group difference effect sizes, and predictive validity at a 3‐year follow‐up. The superior alternative algorithms included those that excluded the nausea subcriterion; required withdrawal‐related distress or impairment; increased the AW subcriteria threshold from 2 to 3 items; and required tremulousness for AW symptom assignment.
Conclusions
The results indicate that the DSM‐5 definition of AW, as assessed by the AUDADIS‐IV, has low specificity. This shortcoming can be addressed by making the algorithm for symptom assignment more stringent.
We used NESARC data to study the concurrent and predictive validity of the DSM‐5 symptom of Alcohol Withdrawal (AW) among adult drinkers. Many of those given AW reported only modest levels of alcohol use, and it appears that reports of hangover were commonly conflated with DSM‐5 AW. The validity and especially the specificity of AW is greatly increased by making the algorithm for the symptom more stringent, such as by removing the AW subcriterion of nausea, or, requiring AW‐related impairment.