The rarity of craving (1.3%) and the lack of additional cases identified can be seen as both a benefit and a drawback. If the addition of craving resulted in substantially increased prevalence and/or changed correlates of alcohol dependence (as is the case with a quantity/frequency indicator (Keyes et al., 2009)), we might consider whether diagnostic sensitivity and specificity would be adversely affected by its inclusion. On the contrary, craving does not modify the descriptive epidemiology of alcohol dependence, indicating that a similar number of cases would be identified with a diagnosis that in its totality provides a more discriminating test, better differentiating individuals along the latent trait of alcohol disorders. Further, given associations with early onset, chronicity, and major depression, the presence of craving may indicate a more severe phenotype compared to alcohol dependent individuals without craving. Given the associations of alcohol craving with a genetic variant (Foroud et al., 2007), the inclusion of craving may be useful for progress in genetic epidemiology. More analyses with diverse, genetically-informative data would be useful to fully understand the phenotypic implications of alcohol
