Disentangling alcohol-specific alcohol use disorder criteria from externalizing psychopathology using an empirically driven approach

Abstract

Within current mental disorder classification systems, alcohol use disorder (AUD) and psychopathology, more broadly, are conceptualized as distinct categorical disorders. Recent classification research has focused on commonalities across disorders to better understand psychopathology, with many arrangements combining AUD with other externalizing disorders, like conduct disorder and antisocial personality disorder. However, the focus on commonalities of AUD with externalizing disorders may preclude insight into possible unique aspects of AUD that can inform AUD classification and treatment targets. The present study aimed to identify AUD symptoms more uniquely associated to alcohol use (versus an externalizing process), using a newly developed analytic procedure, combinatorial optimization. First, we identified AUD symptom sets based on standard and alcohol-specific consumption measures. The symptom sets were then compared to existing diagnostic measures and AUD correlates to determine whether distinct relationships between standard and alcohol-specific symptom sets emerged. Results indicated standard AUD symptom sets outperformed alcohols-specific sets in most cases, with more robust relationships between standard sets and AUD correlates These findings have several clinical and research implications, such as the importance of accounting for externalizing processes in the classification and treatment of AUD. Future research is necessary to determine how to best target unique processes integral to AUD.