Mejldal, A., Andersen, K., Bilberg, R., Braun, B., Bogenschutz, M.P., Bühringer, G., Nielsen, A.S., Behrendt, S.

The Alcohol Dependence Scale and DSM-5 alcohol use disorder: Severity ratings correspond insufficiently in older patients


International Journal of Methods in Psychiatric Research, 29(1), e1811. doi: 10.1002/mpr.1811

Open Access:

Objectives: To investigate the psychometric properties of the frequently used Alcohol Dependence Scale (ADS) in older adults and the associations between ADS scores and alcohol use and DSM-5 AUD symptom counts.

Methods: Using baseline data from an international multicenter RCT on outpatient AUD treatment for adults aged 60+ with DSM-5 alcohol use disorder (AUD; n = 529), we computed Cronbach's alpha (?) and applied confirmatory (CFA) and exploratory factor analysis (EFA) to determine the underlying factor structure. A structural equation model (SEM) explored the interrelationship of latent ADS factors with alcohol use and number of DSM-5 criteria endorsed.

Results: Internal consistency of the ADS ( ? = 0.81) was good. EFA revealed a three-factor structure. Factor 1 (“Severe withdrawal symptoms”) consisted of severe psychoperceptual and psychophysical consequences of excessive drinking, Factor 2 (“Loss of control”) consisted of acute physical reactions of intoxication, and Factor 3 (“Obsessive–compulsive drinking”) described habitual drinking. The SEM suggested that only Factor 3 had large effects on DSM?5 symptom score and drinking behavior.

Conclusion: Lowering the ADS threshold or focusing on ADS items from Factor 3 may be more suitable measures of severity of alcohol dependence in treatment-seeking older adults as ADS scores are low and not closely related to DSM-5 AUD.


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