Is lower severity alcohol use disorder qualitatively different than more severe manifestations? An evaluation of multivariate symptom clusters

Background and Aims Alcohol use disorder (AUD), since the release of DSM‐V, is conceptualized and studied as a unidimensional construct. However, previous research has identified clusters of AUD symptoms related to excessive consumption/tolerance, loss of control/social dysfunction and withdrawal/craving that have shown differential genetic risks, personality associations and predictive ability. Although past ‘variable‐centered’ (e.g. factor‐analytic) studies have demonstrated the importance of these clusters, the current study aimed to examine how these clusters commonly manifest using a ‘person‐centered’ approach (e.g. latent class). Design Cross‐sectional in‐person assessment. Setting Indiana, USA. Participants A convenience sample of 1390 young adults (mean age = 21.43, SD = 2.47) recruited for an over‐representation of alcohol problems (65% with AUD). Measurements Latent class analysis (LCA) was conducted on 23 criteria from the Semi‐Structured Interview on the Genetics of Alcoholism (SSAGA) that align with DSM‐V AUD symptoms. Identified latent classes were characterized using multinomial regressions to examine the association of class and measures of alcohol use, other externalizing psychopathology, internalizing problems and personality. Findings LCA results identified a ‘Low Problems’ class (34% of sample), a ‘Heavy Consumption’ class (26%) characterized by high endorsement probabilities of essentially only consumption/tolerance symptoms, a ‘Consumption and Loss of Control’ class (31%) characterized by endorsing consumption/tolerance and loss of control/social dysfunction symptoms, and finally a ‘Consumption, Loss of Control and Withdrawal’ class (9%) characterized by high endorsement probabilities of all symptom clusters. Multinomial regression results indicated an increasing spectrum of severity in terms of psychological impairment. Conclusions AUD appears to manifest as different clusters of symptoms at different severity levels.