The following is a summary of “Diagnostic Criteria for Identifying Individuals at High Risk of Progression From Mild or Moderate to Severe Alcohol Use Disorder,” published in the October 2023 issue of Substance Use and Addiction by Miller et al. 

A recent study analyzed alcohol use disorder (AUD) criteria to understand severity levels beyond just counts. Conducted across two COGA cohorts in the United States, it assessed data from 1991 to 2019. Researchers sought to identify key criteria signaling severe AUD and determine if certain criteria within mild-to-moderate AUD predicted increased risk for severe AUD.

In the study, 13,110 individuals from the cross-sectional COGA cohort (average age: 37.8 [14.2] years) and 2,818 from the longitudinal COGA cohort (average baseline age: 16.1 [3.2] years) were part of the analysis. The findings suggested that while more criteria indicated higher severity, specific high-risk criteria (e.g., withdrawal) within mild-to-moderate AUD (2-5 criteria) revealed heavier drinking and increased psychiatric issues, even when criterion counts varied. 

Longitudinally, individuals with prior mild-to-moderate AUD and at least 1 high-risk criterion showed faster progression to severe AUD (adjusted hazard ratio [aHR], 11.62; 95% CI, 7.54-17.92) compared to those without high-risk criteria (aHR, 5.64; 95% CI, 3.28-9.70), regardless of criterion count.

The research findings indicated that solely counting criteria for AUD diagnosis might overlook variations among criteria. Prioritizing specific high-risk criteria could better pinpoint individuals at the highest risk, potentially enhancing the understanding and identification of severe AUD development.

Source: jamanetwork.com/journals/jamanetworkopen/fullarticle/2810438