It is noteworthy that the large discrepancies we observed in lifetime diagnoses appeared to be mostly restricted to the abuse and not the dependence diagnosis. In recent years the abuse construct has come under increasing criticism for a number of reasons (Martin, Chung, & Langenbucher, 2008; Vergés, Steinley, Trull, & Sher, in press). For example, the use of one-criterion symptom thresholds can potentially lead to many assessment issues, such as increased heterogeneity among diagnostic groups and decreased reliability. Considering that symptoms contributing to the lifetime diagnosis for abuse in NESARC were operationalized with frequency embedded within the question (i.e., “more than once”; see Table 1), the one criterion threshold for abuse becomes especially problematic. For instance, an individual could diagnose with lifetime abuse in NESARC by reporting driving after having too much to drink only twice over a period of many years. This does not appear to be an optimal conceptualization of persistent or recurrent behavior. Further, considering the wording of some items (e.g., more than once drive a car or other vehicle while you were drinking; see Table 1),
