Subthreshold problem drinkers in DSM-5 alcohol use disorder classification

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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.


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.


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)

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