Gender and Race-Ethnic Differentials in the Criterion Structure of Alcohol Use Disorders

This study explored alcohol use disorder (AUD) criteria across gender and race-ethnicity groups. A two-parameter logistic Item Response Theory (IRT) model was estimated, and an IRT based Differential Criterion Functioning (DCF) analysis was performed on the existing DSM-IV AUD criteria and a proposed consumption-based criterion. There were very few AUD criteria that exhibited DCF by sex and race-ethnicity. The criteria reflecting impaired control and activities given up had significantly lower discrimination among men than women. The consumption-based criterion had higher discrimination but lower severity among men than women. Other criteria that were significantly higher in terms of severity among men than women were withdrawal, drinking more or for longer than intended and neglect of role responsibilities. Discrimination associated with tolerance, impaired control and consumption criteria was significantly lower among Whites than Blacks, although severity associated with these criteria were lower for Blacks than Whites. No differences were observed for Hispanics. DCF in discrimination and severity parameters by gender and race-ethnicity occurred in opposing directions. Consequently, the total response curve (TRC), which is measured at the scale level, was virtually identical for each sex and race-ethnicity group. This study demonstrates that when alcohol use disorder criteria are freely estimated within gender and race-ethnic groups, some of the AUD criteria display statistically significant DCF. When considered at the scale level, however, the measurement displays a very small degree of differential scale function. We can conclude that all groups will have similar expected raw scores on the AUD latent trait.