DSM-5 AUD is diagnosed on a continuum of severity based on the number of criteria endorsed (2-3 = mild, 4-5 = moderate, ≥6 = severe),1 and identifying individuals at high risk for severe AUD is a priority. Several studies document increased comorbid burden and reduced likelihood of recovery as a function of increasing criterion count.7,8,9 However, count-based indices are limited by their equal weighting of criteria, suggesting all diagnostic criteria are interchangeable.10 Extensive cross-national psychometric evidence shows that certain AUD criteria (eg, withdrawal) are more likely to be endorsed by those with more severe AUD and may represent superior indicators of risk.11,12,13,14 Thus, criteria heterogeneity is an important factor to consider in the advancement of personalized treatment approaches.15 Whether “high-risk” AUD criteria endorsement results in differing associations with a wide range of psychiatric, genetic, and neurobiological correlates could further guide delineation of risk severity.
