Innovations in the assessment and diagnosis of alcohol use disorder: From clinical symptoms to process mechanisms

Abstract

Alcohol use disorder (AUD) is a significant health concern with significant practical and conceptual limitations to its assessment and diagnosis. Existing semi-structured interviews have limited psychometric support, may not be sufficiently flexible for use in multiple contexts, and access may be restricted due to copyright status. Conceptually, AUD symptoms may represent downstream consequences of prolonged heavy alcohol consumption, are largely atheoretical, overlooking processes relevant to addiction. This dissertation examines several novel diagnostic strategies for AUD which seek to address these limitations. Study one presents a narrative review which critically examines key developments in the nosology and assessment of addictive disorders. Study two evaluates several psychometric properties of a freely accessible, flexible semi-structured interviewing tool in a sample of individuals making a significant AUD recovery attempt. Study three examines the diagnostic validity of several individual indicators of alcohol consumption in an epidemiological and clinical sample. Study four examines the diagnostic validity of an array of psychological and cognitive variables which map onto theorized process mechanisms in addiction, using a case-control design. The results of this dissertation provide initial validation and investigation of three novel tools for AUD diagnosis: First, a semi-structured interviewing tool which indicates strong psychometric properties. Second, specific alcohol consumption indicators which were associated with excellent diagnostic accuracy, sensitivity, and specificity across both community and clinical samples. Third, specific process-based indicators, including specific subscales of drinking motivation and alcohol cue reactivity, which were also associated with excellent diagnostic accuracy, sensitivity, and specificity. Collectively, this dissertation advances the clinical assessment of AUD from multiple perspectives, advancing assessment grounded in the existing diagnostic framework, and laying foundation for the continued advancement of frontier assessment and diagnostic strategies.