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Alcohol Use, Severity and Social Stressors across HIV Status in a Nationally Representative Sample

Williams EC, Joo YS, Glass JE. Alcohol Use, Severity and Social Stressors across HIV Status in a Nationally Representative Sample. Poster session presented at: Research Society on Alcoholism Annual Scientific Meeting; 2014 Jun 22; Bellevue, WA.


THE PREVALENCE OF DSM-IV VERSUS DSM-5 ALCOHOL USE DISORDERS (AUD) IN PRIMARY CARE PATIENTS AT HIGH RISK FOR AUD IN THE CHOICE TRIAL (142 chars 150 chars allowed) KA Bradley, GT Lapham, J Richards, JO Merrill, EC Williams, AK Lee, E Holden, LJ Chavez, DR Kivlahan (chars 99 200 allowed) Affiliations: Group Health Research Institute; HSRandD COIN and General Medical Service, VA Puget Sound; Departments of Medicine, Psychiatry and Behavioral Sciences and Health Services, University of Washington; (chars 193 200 allowed) BACKGROUND: Definitions of DSM-5 alcohol use disorders (AUD) were designed to achieve a similar overall prevalence of AUD as DSM-IV, but little is known about whether this will apply to primary care (PC) populations. This study compared the prevalence of DSM-IV and DSM-5 AUD in a sample of PC patients enrolled in CHOICE, a trial of nurse collaborative care management of patients at high risk for AUD. METHODS. The study sample was recruited from 3 VA PC clinics. Patients were eligible if they: 1) screened positive for alcohol misuse (AUDIT-C 3 women, 4 men), 2) were not in AUD treatment in the past 90 days; and 3) reported frequent heavy episodic drinking at phone screening ( 4 and 5 drinks for women and men, respectively, 2x per week on average, or 1x per week if prior AUD treatment). We report the prevalence of DSM-IV and DSM-5 AUD based on the interviewer-administered Mini-International Neuropsychiatric Interview, and compare the prevalence of DSM-IV alcohol abuse or dependence with the prevalence of mild, moderate, or severe DSM-5 AUD (defined, respectively, as 2-3, 4-5, and 6 or more of the 11 DSM-5 AUD criteria). We compare patients who met criteria for DSM-5 AUD only, to those who met criteria for both DSM-5 and DSM-IV AUD, assessing mental health (MH) comorbidity as a count of 5 common conditions based on validated measures (depression, generalized anxiety, panic, PTSD, or drug use disorders), and readiness to change on a Readiness Ruler. RESULTS: Among 210 PC patients with frequent heavy episodic drinking who have consented and completed baseline interviews to date (90% men and 55% 45-64 years old), 75% met criteria for DSM-IV AUD (12% abuse and 63% dependence) and 88% met criteria for DSM-5 AUD (31% mild, 27% moderate, and 30% severe). All but one patient with DSM-IV AUD met criteria for DSM-5 AUD; 28 patients (13%) met criteria for mild DSM-5 AUD but did not meet criteria for DSM-IV AUD. Compared to the 157 (75%) patients who met criteria for both DSM-IV and DSM-5 AUD, the 28 patients who met criteria for mild DSM-5 AUD but no DSM-IV AUD had lower levels of comorbid MH conditions (0 vs. 35% had 3-5 conditions), with a trend toward greater confidence in their ability to change their drinking (54 vs. 36% very confident; p 0.08). CONCLUSION: This study suggests that use of DSM-5 will identify more patients with mild AUD in PC settings, characterized by less MH comorbidity and potentially greater self-efficacy for changing drinking. 2495 2500 allowed

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