Is there a future for quantifying drinking in the diagnosis, treatment, and prevention of alcohol use disorders?

This commentary is based on a Plenary Address at th 2006 Meetingof the International Society for Biomedical Research on Alcoholism (ISBRA) held in Sydney, Australia, which posed the simple question: Is There a Future for Quantifying Drinking in the Diagnosis, Treatment, and Prevention of Alcohol Use Disorders? The intention is to stimulate dialogue among the many disciplines represented in the alcohol field about where we should be going with respect to diagnostic criteria for alcohol use disorders (AUDs), now that the American Psychiatric Association (APA) and the World Health Organization (WHO) have launched initiatives for the construction of the fifth revision of the APA Diagnostic and Statistical Manual (DSM-V) and the l1th edition of the WHO International Classification of Diseases (ICD-11). Our position is that quantifying drinking is very relevant to the diagnosis, treatment, and prevention of AUDs. Good examples are the diagnostic criteria developed over time for other complex diseases (e.g. hypertension and diabetes), in which diagnoses are a combination of quantifiable measures (e.g. blood pressure and blood glucose level) and risk factors for disease (e.g. age, weight, lifestyle, and co-morbid conditions). For each of these disorders, diagnostic criteria have developed from simple cutpoints (e.g. diastolic and systolic blood pressure cutpoints for diagnosing hypertension in relation to heart attack and stroke), but have been continually refined as data on other dimensions of risk became available. The data to develop multidimensional, scalable diagnostic criteria for AUDs similar to those for hypertension (National Heart, Lung, and Blood Institute, 2001a), diabetes (American Diabetes Association, 2006), and high blood cholesterol (National Heart, Lung, and Blood Institute, 2001b) are not yet sufficiently refined owing to the absence of quantifiable biomarkers. However, as described below, we do have enough data to begin developing diagnostic criteria for AUDs based on symptom severity and the quantification of …

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