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Alcohol Clin Exp Res. 2016 Aug;40(8):1728-36. doi: 10.1111/acer.13134. Epub 2016 Jul 18.

A Cross-National Examination of Differences in Classification of Lifetime Alcohol Use Disorder Between DSM-IV and DSM-5: Findings from the World Mental Health Survey.

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National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
Department of Epidemiology, Services, and Prevention Research (DESPR), National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Bethesda, Maryland.
College of Medicine, Al-Qadisiya University, Diwania governorate, Iraq.
National School of Public Health, Management and Professional Development, Bucharest, Romania.
Department of Studies on Alcoholism and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland.
School of Psychology, University of Ulster, Belfast, Ireland.
IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain.
Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia.
Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil.
Nova Medical School/Faculdade Ciencias Medicas-Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.



The current study sought to examine the diagnostic overlap in DSM-IV and DSM-5 alcohol use disorder (AUD) and determine the clinical correlates of changing diagnostic status across the 2 classification systems.


DSM-IV and DSM-5 definitions of AUD were compared using cross-national community survey data in 9 low-, middle-, and high-income countries. Participants were 31,367 respondents to surveys in the World Health Organization's World Mental Health Survey Initiative. The Composite International Diagnostic Interview, version 3.0, was used to derive DSM-IV and DSM-5 lifetime diagnoses of AUD. Clinical characteristics, also assessed in the surveys, included lifetime DSM-IV anxiety; mood and drug use disorders; lifetime suicidal ideation, plan, and attempt; general functional impairment; and psychological distress.


Compared with DSM-IV AUD (12.3%, SE = 0.3%), the DSM-5 definition yielded slightly lower prevalence estimates (10.8%, SE = 0.2%). Almost one-third (n = 802) of all DSM-IV abuse cases switched to subthreshold according to DSM-5 and one-quarter (n = 467) of all DSM-IV diagnostic orphans switched to mild AUD according to DSM-5. New cases of DSM-5 AUD were largely similar to those who maintained their AUD across both classifications. Similarly, new DSM-5 noncases were similar to those who were subthreshold across both classifications. The exception to this was with regard to the prevalence of any lifetime drug use disorder.


In this large cross-national community sample, the prevalence of DSM-5 lifetime AUD was only slightly lower than the prevalence of DSM-IV lifetime AUD. Nonetheless, there was considerable diagnostic switching, with a large number of people inconsistently identified across the 2 DSM classifications.


Alcohol Use Disorder; DSM-5; DSM-IV; Prevalence

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Conflict of interest statement

Declaration of interest: The views and opinions expressed in this paper are those of the authors only and do not necessarily represent the views, official policy or position of the US. Department of Health and Human Services or any of its affiliated institutions or agencies. Dr. Glantz’s role on this paper is through his involvement as a Science Officer on U01-MH60220. He had no involvement in the other cited grants. In the past three years, Dr. Kessler has been a consultant for Hoffman-La Roche, Inc., Johnson & Johnson Wellness and Prevention, and Sonofi-Aventis Groupe. Dr. Kessler has served on advisory boards for Mensante Corporation, Johnson & Johnson Services Inc. Lake Nona Life Project, and U.S. Preventive Medicine. Dr. Kessler is a co-owner of DataStat, Inc. The Psychiatric Enquiry to General Population in Southeast Spain – Murcia (PEGASUS-Murcia) Project has been financed by the Regional Health Authorities of Murcia (Servicio Murciano de Salud and Consejería de Sanidad y Política Social) and Fundación para la Formación e Investigación Sanitarias (FFIS) of Murcia.

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