Objective: Several investigators have questioned the validity of the DSM-IV Alcohol Use Disorders criteria for diagnosing alcohol use problems among teenagers, with specific concerns about their utility across different subgroups. In the current study, we examined whether particular racial/ethnic or gender subgroups varied in the incidence and onset age of Alcohol Use Disorder symptoms.
Method: Members of a sample composed of 1,045 community-dwelling "drinkers" (59.4% male; 13.8% black, 21.2% foreign-born Hispanic, 30.7% U.S.-born Hispanic and 33.6% non-Hispanic white) were interviewed retrospectively using the Composite International Diagnostic Interview. The first occurrence of each DSM-IV symptom in a participant was examined by race/ethnicity and gender. Discrete-time event history analysis compared onset patterns from ages 14 through 20 years.
Results: The cumulative incidence of Alcohol Abuse and Alcohol Dependence diagnoses, as well as one alcohol abuse symptom and four dependence symptoms, varied by race/ethnicity. The incidence of both diagnoses, as well as two alcohol abuse symptoms, varied by gender. Event history analysis revealed no significant subgroup variation in first onset patterns for only three of the eleven symptoms. Racial/ethnic variation, but not gender variation, was significant for three symptoms, and both racial/ethnic variation and gender variation was significant for the remaining five symptoms.
Conclusions: Our findings indicate that most of the DSM-IV Alcohol Use Disorder symptoms, when applied to adolescents, demonstrate significant subgroup variation in incidence and onset age patterns. These results speak to the urgent need for additional research concerning the nosology and diagnosis of alcohol use problems among younger drinkers, especially among specific racial/ethnic and gender subgroups.