{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:26:18Z","timestamp":1788960378060,"version":"build-2803163510"},"reference-count":53,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n \n Current\n Diagnostic and Statistical Manual of Mental Disorders<\/jats:italic>\n (Fifth Edition) (\n DSM-5<\/jats:italic>\n ) diagnoses of substance use disorders rely on criterion count\u2013based approaches, disregarding severity grading indexed by individual criteria.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine correlates of alcohol use disorder (AUD) across count-based severity groups (ie, mild, moderate, mild-to-moderate, severe), identify specific diagnostic criteria indicative of greater severity, and evaluate whether specific criteria within mild-to-moderate AUD differentiate across relevant correlates and manifest in greater hazards of severe AUD development.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study involved 2 cohorts from the family-based Collaborative Study on the Genetics of Alcoholism (COGA) with 7 sites across the United States: cross-sectional (assessed 1991-2005) and longitudinal (assessed 2004-2019). Statistical analyses were conducted from December 2022 to June 2023.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n Sociodemographic, alcohol-related, psychiatric comorbidity, brain electroencephalography (EEG), and AUD polygenic score measures as correlates of\n DSM-5<\/jats:italic>\n AUD levels (ie, mild, moderate, severe) and criterion severity\u2013defined mild-to-moderate AUD diagnostic groups (ie, low-risk vs high-risk mild-to-moderate).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 13\u202f110 individuals from the cross-sectional COGA cohort (mean [SD] age, 37.8 [14.2] years) and 2818 individuals from the longitudinal COGA cohort (mean baseline [SD] age, 16.1 [3.2] years) were included. Associations with alcohol-related, psychiatric, EEG, and AUD polygenic score measures reinforced the role of increasing criterion counts as indexing severity. Yet within mild-to-moderate AUD (2-5 criteria), the presence of specific high-risk criteria (eg, withdrawal) identified a group reporting heavier drinking and greater psychiatric comorbidity even after accounting for criterion count differences. In longitudinal analyses, prior mild-to-moderate AUD characterized by endorsement of at least 1 high-risk criterion was associated with more accelerated progression to severe AUD (adjusted hazard ratio [aHR], 11.62; 95% CI, 7.54-17.92) compared with prior mild-to-moderate AUD without endorsement of high-risk criteria (aHR, 5.64; 95% CI, 3.28-9.70), independent of criterion count.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of a combined 15\u202f928 individuals, findings suggested that simple count-based AUD diagnostic approaches to estimating severe AUD vulnerability, which ignore heterogeneity among criteria, may be improved by emphasizing specific high-risk criteria. Such emphasis may allow better focus on individuals at the greatest risk and improve understanding of the development of AUD.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.37192","type":"journal-article","created":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T11:04:01Z","timestamp":1696935841000},"page":"e2337192","source":"Crossref","is-referenced-by-count":25,"title":["Diagnostic Criteria for Identifying Individuals at High Risk of Progression From Mild or Moderate to Severe Alcohol Use Disorder"],"prefix":"10.1001","volume":"6","author":[{"given":"Alex P.","family":"Miller","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally I-Chun","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New 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