The DSM-IV distinguishes between alcohol abuse and dependence, suggesting that abuse indicates more recent initiation of the substance. The abuse diagnosis is preempted by a dependence diagnosis, suggesting that the latter is more severe 7. We examined this categorical distinction between abuse and dependence based on severity. The abuse-dependence distinction is not supported by our results at the symptom level (Figure 2) nor at the diagnostic level (Figure 4). At the symptom level, the severity parameters for the abuse symptoms are interspersed among the dependence symptoms and not clustered along the less severe end of the spectrum, consistent with previous studies 17–19. At the diagnostic level, adolescents categorized into DSM-IV abuse versus dependence differ significantly in their IRT-based estimates of AUD severity. However, there are considerable inconsistencies in the AUD severity of many individuals across DSM-IV diagnostic categories. Taken together, these data suggest that the abuse-dependence distinction currently outlined in DSM-IV might be reconsidered for DSM-V. We provide evidence that a diagnostic system that considers all the abuse and dependence items together will more accurately scale adolescents on AUD severity.
