Impacts of impaired control and pharmacological criteria for lifetime alcohol use disorder on relationships between drinking and problems.

BACKGROUND: The contribution of criteria for lifetime alcohol use disorder (AUD) to greater drinking and problems is infrequently considered in community-based studies of alcohol users. However, theoretical and empirical work indicate that relationships between drinking and problems may be quite different among drinkers reporting impaired control (ic) or pharmacological (p) criteria related to AUD (icpAUD). In this study we measured the extent to which the presence of greater number of these criteria affected dose-response relationships between drinking and problems. METHODS: A survey of 2044 "regular" drinkers reporting use at least twice a month over the previous year assessed respondents' sociodemographic characteristics, impulsivity, drinking motives, sensation seeking, drinking patterns, lifetime AUD criteria (Composite International Diagnostic Interview) and the occurrence of 18 drinking problems over the previous 28 days. Heteroskedastic Tobit regression models were used to measure impacts of two measures of impaired control (impaired control over drinking, inability to stop drinking) and three pharmacological criteria (craving, tolerance, withdrawal) on dose-response relationships between drinking and problems. RESULTS: A dose-response effect was observed among regular drinkers with no criteria (Χ2=53.2, df=1, p < 0.001). Greater number of lifetime icpAUD criteria was related to reduced dose-response (Χ2=6.59, df=1, p = 0.010) and much greater numbers of 28-day drinking problems (Χ2=127.8, df=1, p < 0.001). Substantive nonlinear effects related drinking to 28-day problems across drinkers with greater numbers of lifetime icpAUD criteria. CONCLUSIONS: Measures of impaired control and pharmacological symptom criteria related to lifetime AUD alter dose-response relationships and greatly increase 28-day drinking problems. Therefore, assessments of lifetime AUD criteria are critical to etiological assessments of alcohol problems in community-based studies.