Category: Addictive Behaviors

PS15- #A18 - Revisions to the Diagnosis of Alcohol Use Disorder: DSM-IV Versus DSM-5

Sunday, Nov 19
9:00 AM – 10:00 AM
Location: Indigo Ballroom CDGH, Level 2, Indigo Level

Keywords: Alcohol

In 2013 The American Psychological Association released the 5th edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-5). This newer edition merged the Substance Abuse and the Substance Dependency criteria from DSM-IV into a single diagnosis, Substance Use Disorder (SUD).


One objective of the revision was to improve sensitivity for detecting problem users who went undiagnosed using the former DSM-IV (“Diagnostic Orphans”). This revision raised a question as to whether these diagnostic orphans truly warranted a diagnosis. The purpose of the study was first to identify college students who endorsed symptom consistent with a DSM-5 alcohol use disorder (AUD) but who did not endorse criteria for DSM-IV diagnosis. Next, this group of “Diagnostic Orphans” was compared with alcohol using students who did not endorse diagnostic symptoms and with those who endorsed symptoms consistent with both DSM-IV and DSM-5 diagnoses.


    First year undergraduate students (N=145) completed a questionnaire packet that assessed drinking behavior, substance-use consequences, drinking motives, and depression symptoms. Participants received a $15 gift card for completing the survey.


Nearly half (N=71) reported drinking alcohol within the past 3 months. These students were clustered into three groups: those who endorsed symptoms consistent with AUD for both DSM-IV and DSM-5 (AUD; N=31), those who endorsed criteria for DSM-5 AUD but no DSM-IV diagnosis (Orphans; N=14), and those not endorsing criteria consistent with either DSM (NoDx; N=25). Orphans consumed alcohol at a level comparable to AUD out of the sample of 145 students. One participant from the drinking sample failed to answer certain items of the survey; therefore, their data was excluded from the analysis. 64% of students that drank alcohol met criteria for a diagnosis. 33% of the 45 students would not have met the previous criteria for either of the DSM IV disorders (n=14). 20% of the students that drank met criteria for DSM IV substance abuse disorder (n = 14). 24% met criteria for a DSM IV substance dependence diagnosis (n = 17), with a combined 44% that would have met criteria for either DSM IV disorder. It is important to note that while the DSM 5 only students more closely resembled the DSM IV and 5 students in terms of the quantity and frequency in which they drank, this data was taken from a college sample of freshmen, and social pressures to make friends could lead to a higher consumption of alcohol. The DSM 5 only group more closely resembled the no diagnosis group in terms of number of problems, severity of problems, and drinking motives than the 4 and 5 diagnosis students. This group also had similar depression scores to the no diagnosis group, and both groups had significantly lower depression scores than the DSM IV groups. These results indicate that the orphans do not share the same pathological profile that would be expected due to a disorder. Future research should investigate the causal relationship between quantity/ frequency and college drinking, as well as other variables that could determine why such a high percentage of seemingly healthy college students meet criteria for an alcohol related disorder.

Ashley McWaters

Pacific University Oregon

Peter Vik

Professor, PhD Program Director
Pacific University Oregon, Oregon

Megan Dorenkamp

Pacific University Oregon