The diagnostic efficiency of the nine DSM-III-R criteria (signs and symptoms) for alcohol dependence was systematically investigated in a sample of 215 psychiatric outpatients. Specificity was generally greater than 0.90, but two groups of criteria were distinguished according to high v moderate sensitivity rates. The diagnostic relevance of all DSM-III-R criteria was strongly supported by a comparison with additional characteristics of alcoholism. Features referring to impaired control over alcohol use and to physical dependence (tolerance and withdrawal) were found to be most clearly discriminating between subjects with and without alcohol dependence. There is strong evidence that two positive criteria are sufficient to reliably diagnose alcohol dependence. A computer-simulated analysis was performed to demonstrate predictive power of single symptoms under different base rate conditions, and results were promising for the most common settings in clinical research.
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