Subthreshold problem drinkers in DSM-5 alcohol use disorder classification

Am J Addict. 2016 Aug;25(5):408-15. doi: 10.1111/ajad.12404. Epub 2016 Jul 19.


Background and objectives: The DSM-5 defined alcohol use disorder (AUD) to better cover undiagnosed subthreshold alcohol users, but few studies have investigated this topic. This study aimed to test whether subthreshold problem drinkers were a distinct subgroup of undiagnosed drinkers according to the DSM-5 AUD classification by investigating drinking patterns and longitudinal trajectories.

Methods: Data were collected in the Cohort Study on Substance Use Risk Factors from young Swiss men in their early twenties (n = 4,630) at two time points. Participants responded to the 11 criteria of the DSM-5 AUD and to variables related to drinking patterns.

Results: Among drinkers, 23.2% and 23.5% of the participants were subthreshold problem drinkers at baseline and follow-up, respectively. The trends showed that 29.4% of them remained subthreshold problem drinkers over time. Those who remained subthreshold problem drinkers or progressed to AUD status were likely to meet the same criterion/add a new one. Subthreshold problem drinkers showed concurrent and later drinking patterns that were in between those of symptom-free drinkers and AUD drinkers.

Discussion and conclusion: Subthreshold problem drinkers were an important subgroup of drinkers with risky drinking patterns, but they did not necessarily progress to later AUD status and did not appear to be a consistent subgroup over time.

Scientific significance: Subthreshold problem drinkers did not seem to be a subgroup of undiagnosed problem drinkers in the current DSM-5 classification. The results showed that AUD appeared to be a dimensional construct, in which one additional criterion was associated with worse alcohol-related outcomes. (Am J Addict 2016;25:408-415).

MeSH terms

  • Adult
  • Alcohol Drinking* / epidemiology
  • Alcohol Drinking* / prevention & control
  • Alcohol Drinking* / psychology
  • Alcohol-Related Disorders* / diagnosis
  • Alcohol-Related Disorders* / prevention & control
  • Alcohol-Related Disorders* / psychology
  • Alcoholic Intoxication / prevention & control*
  • Alcoholism* / epidemiology
  • Alcoholism* / prevention & control
  • Alcoholism* / psychology
  • Cohort Studies
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Male
  • Risk Assessment
  • Risk Factors
  • Switzerland / epidemiology
  • Young Adult