Second, craving was added to the remaining 10 DSM-IV criteria, largely motivated by favorable psychometric properties of this criterion in general (38–40) and clinic populations (41). Craving is an element of the ICD-10 (42) classification, is frequently observed in clinic samples (43) and has been well documented to have biological significance (44;45). In our analyses, the inclusion of craving did not substantively contribute to diagnostic switching and the modest degree of switching was largely attributable to the less stringent item on “very strong desire to drink”. In prior analyses of a similarly large and nationally representative dataset, Keyes et al (38) defined craving using the less common “ever wanted a drink so badly” item, which yielded a comparable prevalence of 1.3%. However, as DSM-5 specifically includes “strong desire or urge” in its proposed definition of craving, we utilized both items in these analyses.
