On the validity of the research diagnostic criteria, the Feighner criteria, and the DSM-III for diagnosing alcoholics.

A 10-item Trouble-Due-To-Drinking Scale, similar to the Feighner Criteria, the Research Diagnostic Criteria (RDC), and the DSM-III Alcoholism Criteria, was tested for its ability to identify a population of clinic alcoholics (N = 2459) and a sample of nonclinic "designated" alcoholics (N = 169). The Trouble Scale identified only 27 per cent of the nonclinic cases with substantial sex, age, income, and educational biases. It identified 77 per cent of the clinic cases, with much less apparent bias. If the clinic cases are a representative sample of alcoholics at large, then the Trouble Scale, and by implication the Feighner Criteria, the RDC, and the DSM-II, represent progress in the development of valid (useful) alcoholism diagnostic criteria. If, however, the nonclinic cases are more representative of all alcoholics, then the poor performance of the Trouble Scale applied to these cases indicates that it and similar alcoholism criteria that are based on the trouble dimension, are fatally flawed by bias. In either case, much developmental work remains to be done at both the conceptual and operational levels before there is valid criteria for diagnosing alcoholism.