The Alcohol Dependence Scale and DSM-5 alcohol use disorder: Severity ratings correspond insufficiently in older patients

Research output: Contribution to journalResearch articleContributedpeer-review


  • Anna Mejldal - , University of Southern Denmark (Author)
  • Kjeld Andersen - , University of Southern Denmark (Author)
  • Randi Bilberg - , University of Southern Denmark (Author)
  • Barbara Braun - , Therapy Research Institute (Institut für Therapieforschung) (Author)
  • Michael Bogenschutz - , The Child Study Center at NYU Langone Medical Center, University of New Mexico (Author)
  • Gerhard Bühringer - , Institute of Clinical Psychology and Psychotherapy, University of Southern Denmark, Therapy Research Institute (Institut für Therapieforschung) (Author)
  • Anette Søgaard Nielsen - , University of Southern Denmark (Author)
  • Silke Behrendt - , University of Southern Denmark (Author)


To investigate the psychometric properties of the frequently used Alcohol Dependence Scale (ADS) in older adults and the associations between ADS scores and alcohol use and DSM-5 AUD symptom counts.

Using baseline data from an international multicenter RCT on outpatient AUD treatment for adults aged 60+ with DSM-5 alcohol use disorder (AUD; n = 529), we computed Cronbach's alpha (α) and applied confirmatory (CFA) and exploratory factor analysis (EFA) to determine the underlying factor structure. A structural equation model (SEM) explored the interrelationship of latent ADS factors with alcohol use and number of DSM-5 criteria endorsed.

Internal consistency of the ADS (α = 0.81) was good. EFA revealed a three-factor structure. Factor 1 (“Severe withdrawal symptoms”) consisted of severe psychoperceptual and psychophysical consequences of excessive drinking, Factor 2 (“Loss of control”) consisted of acute physical reactions of intoxication, and Factor 3 (“Obsessive–compulsive drinking”) described habitual drinking. The SEM suggested that only Factor 3 had large effects on DSM-5 symptom score and drinking behavior.

Lowering the ADS threshold or focusing on ADS items from Factor 3 may be more suitable measures of severity of alcohol dependence in treatment-seeking older adults as ADS scores are low and not closely related to DSM-5 AUD.


Original languageEnglish
Article numbere1811
JournalInternational journal of methods in psychiatric research
Issue number1
Publication statusPublished - 2020

External IDs

Scopus 85076084350