We examined past-year alcohol use in NESARC for those with exactly two, three, four and five past-year DSM-5 AUD symptoms. The number of standard drinks usually consumed on drinking days averaged a modest 3.79 (s.e. = 0.09) for those with two symptoms, and was 4.58 (s.e. =0.19), 4.64 (s.e. =0.16) and 5.33 (s.e. =0.25) for those with three, four and five symptoms, respectively. Drinking five or more standard drinks per occasion at least weekly was reported by only 28.33% of the two-symptom group, but this percentage rose to 38.08, 47.22 and 54.14% among those with three, four and five symptoms, respectively. These data suggest that the 2/11 algorithm would diagnose very mild cases that do not have the compulsive patterns of use that are thought to characterize ‘addiction’ in modern theory (Koob & Le Moal, 1997; Robinson & Berridge, 2003). This would be inconsistent with the traditional DSM definition of mental disorders as syndromes that reflect dysfunction in internal mechanisms (Wakefield & First, 2003), such as neuroadaptations that ‘hijack’ the brain's reward and incentive salience systems, leading to substance use.
