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Characteristics of DSM-5 Alcohol Use Disorder Diagnostic Orphans in College: An Overlooked Group of Drinkers

Hagman, Brett, T., PhD

Addictive Disorders & Their Treatment: March 2018 - Volume 17 - Issue 1 - p 1–12
doi: 10.1097/ADT.0000000000000116
Original Articles

Objectives: Under the new DSM-5 Alcohol Use Disorder (AUD) diagnostic system, there remains a residual set of subthreshold drinkers, who endorse only 1 AUD criterion, and do not receive a formal diagnosis, despite being at-risk for developing alcohol problems. The present study sought to evaluate differences between DSM-5 diagnostic orphans in college compared with those who do and do not receive a DSM-5 AUD diagnosis across measures of alcohol use involvement, alcohol-related correlates and emotion regulation capacity.

Methods: Participants were 396 current undergraduate drinkers in college recruited from a large university in the NE part of the United States. Each participant filled out an anonymous online questionnaire.

Results: DSM-5 diagnostic orphans (DOs) represented approximately 24% (n=95) of the sample. They reported greater levels of alcohol use (quantity/frequency), consequences from drinking, and social/enhancement motives for drinking compared with those without a DSM-5 AUD. Alternatively, DSM-5 DOs reported significantly lower levels of alcohol use involvement, consequences from drinking, social, coping and enhancement motives for drinking, emotion dysregulation, and drinking restraint compared with those with a DSM-5 AUD.

Conclusions: DSM-5 DOs in college constitute as a unique at-risk group of drinkers in comparison with those with and without a DSM-5 AUD diagnosis. It is critical that our screening, referral and brief intervention efforts in university settings incorporate procedures to target this at-risk group of drinkers to deter escalation of future alcohol problems.

Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, MD

The contents of this manuscript only reflect the views of the authors and not those of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) or the National Institutes of Health.

Funded by internal research funds from Rutgers, the State University of New Jersey.

The authors declare no conflict of interest.

Reprints: Brett T. Hagman, PhD, Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism (NIAAA), 5635 Fishers Lane, Room 2044, Bethesda, MD 20892 (e-mail:

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