Many of the 6 empirically identified high-risk criteria have previously demonstrated stronger associations with comorbid psychopathology and greater severity of and discriminatory capabilities for AUD than other criteria.13,37,38,39 However, these high-risk criteria do not currently comprise a coherent DSM-5 AUD subtype.40 For example, although DSM-5 characterizes both withdrawal and tolerance as physiological components of AUD, withdrawal but not tolerance was identified as high risk. Interestingly, several of the high-risk criteria were markers of preoccupation (eg, craving, time spent, giving up/reducing important activities) and impairment in several domains (eg, role obligations, recurrent physical/psychological problems, withdrawal). These criteria were endorsed far more frequently by individuals with severe AUD and map onto 2 key stages (preoccupation/anticipation and withdrawal/negative affect) of one of the neurobiological models developed to characterize severe forms of SUDs.41
