Diagnosing Alcohol Dependence
Diagnosing a mental disorder is often a complicated process, with a long list of criteria often presenting very differently in each individual. Much of the information gathered to determine whether a diagnosis is appropriate is gathered using reports from the individual being diagnosed, and some of the information may not be reliable.
When compared with other psychiatric disorders, the reliability of the diagnostic tools set forth by the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition is relatively stable. When interviewing individuals from the general public, however, their estimates of past experience or lifetime history of psychiatric or substance abuse disorders are often unreliable.
A new study examined the reliability of the DSM-IV lifetime history of alcohol dependence in a population-based sample. The researchers found that when a diagnosis is based on a single interview, the results are reliable. The study, which will be published in the September 2011 issue of Alcoholism: Clinical & Experimental Research, was conducted by Eivind Ystrom and colleagues at the Norwegian Institute of Public Health.
Ystrom explained that the researchers wanted to explore the accuracy of diagnostic interviewing because people tend to be very inaccurate when interviewed about a history of psychiatric symptoms. This is usually because people don’t recall when prompted about certain events. As a result, the researchers hoped that by interviewing individuals several times about the same disorder that it might be possible to quantify how often people are accurate.
The researchers recruited a sample of 4,203 male twins in Virginia who had been assessed for lifetime alcohol dependence two different times, with the assessments occurring one year apart. The researchers used logistic regression analysis to identify clinical features that might be reliable for diagnosing alcohol dependence. The team also examined whether genetic and environmental influences were a factor.
The researchers found that certain variables were useful in predicting the reliability of the diagnosis. Not all of the symptoms that are predictive of alcohol dependence were useful in achieving a reliable diagnosis for the patient.
One of the key discoveries that the researchers identified was that men who are diagnosed with lifetime history of alcohol dependence accurately using a clinical interview had at some point in their lives sought treatment for alcohol dependence. In addition, they had experienced a relatively long period of alcohol dependence, and they spent extensive time in obtaining alcohol or recovering from alcohol use.
The results of the study show that the diagnosis of alcohol dependence may be measured accurately by determining the individual’s history on a few key measures.