Seven Symptoms Over Nearly 4,000 Days: Item-Level Variability in the Psychometric Properties of Daily Alcohol Use Disorder Symptoms in Young Adult Drinkers

People experience symptoms of alcohol use disorders (AUD) in their daily lives, including more impairment-based symptoms (e.g., hazardous use, interpersonal problems) and symptoms based on the intensity or frequency of consumption (e.g., cravings or limit violations). We estimated the psychometric properties of seven manifestations of daily AUD symptoms in a high-risk sample of regularly drinking young adults and identified the optimal operationalization and thresholds for those symptoms. We estimated item response theory (IRT) models in ecological momentary assessment data (n = 527, age 18–22, 45% female) assessed over 3,963 alcohol use days. Symptoms were relatively common on drinking days, especially symptoms related to consumption (such as time spent drinking or consuming larger among than intended). The specific threshold or item used to define each AUD symptom could have a substantial impact on item parameters. Tolerance was best loaded onto a factor of daily AUD symptoms when operationalized as sensitivity to the effects of alcohol, while larger/longer was best reflected as drinking much more than intended (e.g., 3+ drinks). Daily life research focusing only on alcohol-related consequences misses important information about common experiences of AUD symptoms in daily life. Refinement of daily measures of AUD symptoms could help researchers understand how the disorder develops over time.

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