The introduction of measures of alcohol consumption together with a clinical approach of categorical diagnosis is promising but two limitations exist based on prior analysis in the general population. First, these results need to be replicated using different datasets, especially those across various types of clinical practice in which patients under consultation tend to have more symptoms and more severe symptoms than general population samples, such as NESARC. Secondly, it is not clear what the impact may be, across countries and cultures, of introducing consumption into the DSM-IV alcohol use disorder diagnostic criteria. In 2004 NIAAA published guidelines for at-risk drinking (that which increases the risk of developing alcohol use disorders, morbidity and mortality), defined as 5 or more drinks per occasion for males and 4 or more for females (5+/4+)[10]. While drinking 5+/4+ at least once a week in the past year is, indeed, a marker of heavy episodic drinking, this measure has a large variation in prevalence across cultures, and the variation is not necessarily in the same direction as variation in alcohol abuse and dependence. For example,
