Modern nosologies (e.g., International Classification of Diseases, 11th edition [ICD-11], Diagnostic and Statistical Manual of Mental Disorders, 5th edition [DSM–5]) for alcohol use disorder (AUD) and dependence prioritize reliability and clinical presentation over etiology, resulting in a diagnosis that is not always strongly grounded in basic theory and research. Within these nosologies, DSM–5 AUD is treated as a discrete, largely categorical, but graded, phenomenon, which results in additional challenges (e.g., significant phenotypic heterogeneity). Efforts to increase the compatibility between AUD diagnosis and modern conceptualizations of alcohol dependence, which describe it as dimensional and partially overlapping with other psychopathology (e.g., other substance use disorders), will inspire a stronger scientific framework and strengthen AUD’s validity. We conducted a systematic review of 144 reviews to integrate addiction constructs and theories into a comprehensive framework to identify fundamental mechanisms implicated in AUD. The product of this effort was the Etiologic, Theory-based, Ontogenetic Hierarchical Framework (ETOH Framework) of AUD mechanisms, which outlines superdomains of cognitive control, reward, and negative valence and emotionality, each of which subsume narrower, hierarchically organized components. We also outline opponent processes and self-awareness as key moderators of AUD mechanisms. In contrast with other frameworks, we recommend an increased conceptual role for negative valence and compulsion in AUD. The ETOH framework serves as a critical step toward conceptualizations of AUD as dimensional and heterogeneous. It has the potential to improve AUD assessment and aid in the development of evidence-based diagnostic measures that focus on key mechanisms in AUD, consequently facilitating precision medicine.

中文翻译：

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酒精使用障碍的病因学、基于理论的个体发育层次框架：对评价的转化系统评价。

酒精使用障碍 (AUD) 和依赖的现代分类学（例如，国际疾病分类，第 11 版 [ICD-11]，精神疾病诊断和统计手册，第 5 版 [DSM-5]）将可靠性和临床表现优先于病因，导致诊断并不总是以基础理论和研究为基础。在这些分类学中，DSM-5 AUD 被视为一种离散的、主要是分类的、但分级的现象，这会导致额外的挑战（例如，显着的表型异质性）。努力增加 AUD 诊断与酒精依赖的现代概念化之间的兼容性，将其描述为与其他精神病理学（例如，其他物质使用障碍）的维度和部分重叠，将激发更强大的科学框架并加强 AUD 的有效性。我们对 144 篇评论进行了系统回顾，以将成瘾结构和理论整合到一个综合框架中，以确定涉及 AUD 的基本机制。这项工作的产物是 AUD 机制的病因学、基于理论的个体发生分层框架 (ETOH 框架)，它概述了认知控制、奖励、负效价和情绪的超域，每个域都包含更窄的、分层组织的组件。我们还概述了对手过程和自我意识作为 AUD 机制的关键调节者。与其他框架相比，我们建议在 AUD 中增加负效价和强制的概念作用。ETOH 框架是朝着将 AUD 概念化为维度和异构的关键一步。它有可能改善 AUD 评估并帮助开发以证据为基础的诊断措施，这些措施侧重于 AUD 的关键机制，从而促进精准医疗。