INVESTIGADORES
CREMONTE Mariana
artículos
Título:
Threshold and Optimal Cut-Points for Alcohol Use Disorders Among Patients in the Emergency Department
Autor/es:
BORGES, GUILHERME; CHERPITEL, CHERYL; YE, YU; BOND, JASON; CREMONTE, MARIANA; MOSKALEWICZ, JACEK; SWIATKIEWICKZ, GRAZYNA
Revista:
Alcoholism: Clinical and Experimental Research
Editorial:
Wiley
Referencias:
Año: 2011 vol. 35 p. 1 - 7
ISSN:
1530-0277
Resumen:
Background: Current research suggests that Diagnostic and Statistical Manual of Mental Disorder (DSM)-IV alcohol abuse and dependence form a unidimensional continuum in emergency department (ED) patients in 4 countries: Argentina, Mexico, Poland, and the United States. In this continuum of alcohol use disorder (AUD), there are no clear-cut distinctions between the criteria for dependence and abuse in the severity dimension based on prior results from item response theory (IRT) analysis. Nevertheless, it is desirable to find a threshold for identifying cases for clinical practice and cut-points of clinical utility in this continuum to distinguish betweenpatients more or less affected by an AUD, using a scale of symptoms count. Methods: Data from 5,193 patients in 7 ED sites in the same 4 countries (3,191 current drinkers) were used to study the structure, threshold, and possible cut-points for the diagnoses of AUD.Results: The proposed changes in the DSM-V, dropping the abuse item legal problems and adding an item on craving, did not impact the IRT performance and unidimensionality of AUD in this sample. With a total set of 11 items (deleting legal problems and adding craving to the current set of DSM criteria), an endorsement of 2 or more criteria can be used as the threshold to define those with an AUD in clinical practice. Furthermore, we can distinguish at least 2 levels of clinical severity, 2 to 3 criteria (moderate), and 4 or more criteria (severe). Conclusions: A dimensional approach to AUD using the proposed new set of criteria for the DSM-V can be used to propose a threshold and levels of severity. More research in different populations and countries is needed to further substantiate a threshold and cut-points that could be used in new formulations of substance use disorders