Empirical assessment of the advisability of adding a new criterion can proceed using multiple analytic strategies. First, craving should be subjected to latent variable analysis (factor and item response theory [IRT] analysis) with the existing criteria. Previous studies of the alcohol abuse and dependence criteria indicate that they are arrayed across a single underlying continuum of severity (Gelhorn et al., 2008, Harford et al., 2009, Kahler and Strong, 2006, Krueger et al., 2004, Langenbucher et al., 2004, Martin et al., 2006, Proudfoot et al., 2006, Saha et al., 2006, Wu et al., 2009). Given such a structure, craving should form part of this single underlying latent variable to be a viable candidate for addition to DSM-V. Further, craving would demonstrate diagnostic improvement if the ability of the diagnosis as a whole to discriminate those with and without an alcohol disorder is improved with the addition of a craving criterion.
