Direct comparisons between D4-only and D5-only, which are of greatest interest to evaluating the DSM-5 criteria, indicate that they are quite similar in terms of comorbidities: the only significant differences in clinical features between these groups was age of onset of AUD symptoms and the prevalence of cannabis use disorder. These differences suggest that D4-only has a slightly more severe phenotype. Thus, it is not clear that the proposed diagnostic changes will result in a more accurate diagnosis: at best, one group of low-severity cases will be replaced by another; at worst, a group of individuals who exhibit more severe problems will be excluded from the DSM-5 diagnosis while less severely affected individuals will meet diagnostic criteria.
