Alcohol Use Disorders among Substance Dependent Women on Temporary Assistance with Needy Families: More Information for Diagnostic Modifications for DSM-5

• Published in: The American journal on addictions Vol. 22; no. 4; pp. 402 - 410
• Main Authors: Kuerbis, Alexis N., Hagman, Brett T., Morgenstern, Jon
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.07.2013
• Subjects: Adolescent; Adult; Alcohol related disorders; Alcohol-Related Disorders - diagnosis; Alcohol-Related Disorders - epidemiology; Dependency; Diagnostic and Statistical Manual of Mental Disorders; Factor Analysis, Statistical; Female; Humans; Middle Aged; Modification; Psychiatric disorders; Temporary Assistance for Needy Families; Vulnerable Populations - psychology; Vulnerable Populations - statistics & numerical data; Women
• ISSN: 1055-0496; 1521-0391
• DOI: 10.1111/j.1521-0391.2013.12042.x

Purpose While modifications to alcohol use disorder (AUD) criteria are proposed for DSM‐5, examination of the criteria's performance among highly vulnerable populations is lacking. This study determined the dimensionality and rank order severity of the DSM‐IV AUD criteria among Temporary Assistance for Needy Families (TANF) recipients with high rates of chemical dependency and co‐morbid mental health disorders. Method Secondary analysis was performed on data from 461 TANF eligible women screened for AUD criteria using the Structured Clinical Interview for DSM‐IV‐TR. Exploratory (EFA) and confirmatory factor analyses (CFA) were performed on the AUD criteria. Two‐parameter Item Response Theory (IRT) analysis was performed to determine item location and discrimination of criteria for both abuse and dependence. Differential item functioning for those with an additional substance use disorder or with high levels of depressive symptoms was explored. Results 41.2% met criteria for dependence, and 4.4% for abuse. EFA and CFA revealed a two‐factor model provided adequate fit to criteria, and IRT indicated a potential hierarchical order between the criteria—abuse being more severe but dependence having greater reliability. Conclusion Contrary to existing literature, findings suggest that a two‐factor solution may be appropriate. Implications are discussed. (Am J Addict 2013;22:402–410)