diagnostic orphans are substantially higher (in some cases almost an entire SD higher) than severity estimates for many persons diagnosed with abuse. A similar pattern is evident across abuse and dependence. For example, some persons diagnosed with abuse have alcohol problem severity greater than +2 SDs, while many persons diagnosed with dependence have alcohol problem severity well below +2 SDs. A figure showing IRT-based estimates of alcohol use problem severity by total alcohol symptom count is available on the Journal’s Web site at www.jaacap.com through the Article Plus feature. With few exceptions, those who endorse 1 alcohol abuse or dependence symptom have AUD severity less than 1 SD greater than the mean. Persons who endorse 4 or more alcohol abuse or dependence symptoms largely have AUD severity greater than 2 SDs above the population mean.
