We used NESARC to estimate the past-year prevalence for DSM-IV alcohol dependence (5.02%) and any DSM-IV AUD (abuse plus dependence; 11.06%). Results for the proposed DSM-5 criterion set showed that a 2/11 threshold produced a past-year AUD rate of 12.40%, which dropped to 7.25% with a 3/11 threshold, 4.48% with a 4/11 threshold, and 2.93% with a 5/11 threshold. Although the prevalence estimates produced by the 2/11 and 3/11 thresholds were closest to that for any DSM-IV AUD, we do not believe that DSM-5 should be designed to emulate DSM-IV in this way. There are serious problems with the validity of the DSM-IV substance-abuse category, including over-diagnosis (Martin et al. 2008; Verges et al. 2010), such that it should not be part of a target for SUD prevalence in DSM-5. DSM-IV alcohol dependence, a category with considerably more construct validity, represents a more reasonable comparator and is closest in prevalence to a 4/11 threshold.
