The preceding discussion covering definitions of diagnosis and the drug dependence syndrome, along with a description of the DSM criteria for substance-related disorders, provide the conceptual rationale for choosing the instruments that are reviewed in this chapter. Instruments designed to help obtain DSM or ICD diagnoses of alcohol (or, more generally, substance) related disorders are included. More focused measures relating to the dependence syndrome and to the criteria for formal diagnoses are also covered. Therefore, measures of consequences of alcohol use, control over alcohol use, urges and craving (to consume alcohol), and withdrawal are discussed. These latter measures, along with instruments designed to yield formal diagnoses, together are referred to in this chapter as "diagnostic measures.' Validity of Psychiatric Diagnosis 99 In the course of research on psychiatric taxonomic systems in the United States, generally accepted criteria for evaluating the validity of diagnostic categories have evolved. These criteria include clinical description, laboratory studies, delimitation from other disorders, followup studies (i.e., stability and prognostic value of a diagnosis), and family studies, which pertain to etiology of disorders (Todd and Reich 1989; Woodruff et al. 1977, p. 443). Essentially, these criteria specify that valid diagnostic categories are discrete, are based in etiological research, enhance our ability to predict the course of a disorder, and enable prescriptive treatment assignment. By these standards, the DSM falls considerably short of the mark of a valid diagnostic system. For example, the diagnostic categories in DSM are not for the most part etiologically based because of the limits of our knowledge about the development of most of the identified psychiatric disorders. In addition, knowledge of diagnosis does not lead to prescriptive treatments for the vast majority of disorders, particularly when considering psychosocial treatments (Beutler and Clar kin 1990). In planning treatment, it generally is necessary to go beyond diagnosis, such as by determining the antecedent and consequent conditions of the symptoms and behaviors that constitute a diagnosis. Certainly this is true in psychological and social treatments for the vast majority of cases of alcohol problems. Furthermore, diagnostic categories are not discrete. Instead, there is considerable overlap across some diagnostic categories and heterogeneity within categories. For example, in a general population survey study of DSM-III-R (DSM-IV's predecessor), Grant and associates (1992) found 189 subtypes (466 are possible) of alcohol dependence diagnoses based on combinations of symptoms whose criteria were met in the sample. In addition, the number of subtypes found covaried with subject demographic factors such as gender, age, and race. With the evidence on the validity of diagnoses, it might be legitimately argued that assignment of alcohol-related diagnoses does little to enhance treatment or research. However, there are several compelling reasons for continuing to assign diagnoses as part of clinical and research practice. First, the assignment of diagnoses that can be reliably derived greatly improves communication among clinicians and researchers. That is, diagnoses aid clinical description. Alcohol problems is one area of clinical practice that has been chronically beset with ambiguity and disagreement concerning definition, and the creation of diagnostic criteria that can, for the most part, be operationalized as in the current DSM has alleviated such problems of definition considerably. Improvement in communication among professionals about what they are treating and studying also tends to accelerate advances in research, which in turn will help to refine the diagnostic system itself. Another reason to assign diagnoses is that they can be useful in planning treatments. In this regard, psychiatric diagnostic categories consist of covarying symptoms and behaviors, so that knowing one symptom helps to predict the existence of others. Although this feature alone does not lead to prescriptive treatments, elaboration of detail about symp toms, such as by learning their antecedent and consequent conditions, is essential to treatment planning. Taken together, these advantages provide a solid rationale for continuing to assign diagnoses as part of treatment and research on alcohol use disorders. As a result, we argue that diagnostic measures do have clinical and research utility. We explore this point in more detail below in discussions of individual measures. Diagnostic Measures There is no shortage of measures that could have been chosen for inclusion in this chapter. The 17 measures that were selected for review met the criteria for inclusion outlined in the introduction to the Guide. The full name of each measure and its abbreviation are listed here: • Adolescent Diagnostic Interview (ADI) • Alcohol Use Disorders and Associated • Clinical Institute Withdrawal Assess- • Composite International Diagnostic • Diagnostic Interview Schedule for • The Drinker Inventory of Conse- • Drinking Problems Index (DPI) • Millon Clinical Multiaxial InventoryII (MCMI-II) • Psychiatric Research Interview for • Restrained Drinking Scale (RDS) • Severity of Alcohol Dependence Questionnaire (SADQ) • Substance Use Disorders Diagnostic Schedule (SUDDS) • Temptation and Restraint Inventory (TRI) • Yale-Brown Obsessive-Compulsive Scale (Y-B OC). Table 3 presents a summary of their major features, as indicated by the column headings. The purpose of each measure is listed because several different types of measures (e.g., measures of nomenclature, severity of dependence, and consequences) are called diagnostic in this chapter. Clinical utility is listed because a major aim of this chapter is to address clinicians's assessment needs, and the diagnostic measures vary in the degree to which they assist clinicians in treatment planning, implementation, and evaluation. Training requirement is included because of the substantial variability among the diagnostic measures on that dimension; how accessible a measure is to a clinician or researcher with specific resources could depend in part on the extent of training that is required to use it. The blank cells in table 3 reflect the absence of information from the authors of the respective measures. A number of table entries are "NA," for not applicable. Such entries occur primarily for the column |