The factor structure and severity of DSM-IV alcohol abuse and dependence symptoms in psychiatric outpatients

Objective: The goal of the present study was to examine the factor structure and estimated severity of alcohol-use disorder (AUD) symptoms in a sample of treatment-seeking psychiatric outpatients. Method: Participants (n = 1,027; 51.2% women) met the screening criteria for the lifetime assessment of AUDs according to the Structured Clinical Interview for the DSM-IV (SCID-I/P; First et al., 1995) and as a result completed an assessment of alcohol abuse and dependence symptoms. The average (SD) age of the sample was 36.6 (11.4) years, and 71% of participants met lifetime DSM-IV criteria for an AUD. Results: Exploratory factor analysis of the tetrachorie correlation matrix of alcohol abuse and dependence criteria revealed that a single factor best accounted for the data in this sample. Results of Rasch model analyses indicated that the severity ordering of the DSM-IV abuse and dependence symptoms was not consistent with the hierarchical structure suggested by the DSM-IV Instead, abuse items were found to be spread across a full range of the AUD continuum and were not consistently in the lower ranges of severity. Conclusions: This study extends the literature by examining a treatment-seeking psychiatric outpatient sample and using a semistructured diagnostic interview administered by mental health professionals. Methodological considerations and implications for the conceptualization of AUD are discussed.