Journal
DRUG AND ALCOHOL DEPENDENCE
Volume 127, Issue 1-3, Pages 215-219Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.drugalcdep.2012.07.009
Keywords
DSM-IV; DSM-5; Substance use disorders; Substance abuse; Substance dependence
Categories
Funding
- Alcohol Clinical Trials Initiative (ACTIVE) of the American College of Neuropsychopharmacology
- Eli Lilly
- Janssen
- Schering Plough
- Lundbeck
- Alkermes
- GlaxoSmithKline
- Abbott
- Johnson Johnson
- NIH [DA12690, DA12849, DA18432, AA11330, AA017535]
- VISN1 Veterans Affairs Mental Illness Research, Education, and Clinical Center
- VISN4 Veterans Affairs Mental Illness Research, Education, and Clinical Center
- NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM [R01AA017535, K24AA013736, R01AA011330] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE ON DRUG ABUSE [R01DA012690, R01DA018432, R01DA012849] Funding Source: NIH RePORTER
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Background: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will soon replace the DSM-IV, which has existed for nearly two decades. The changes in diagnostic criteria have important implications for research and for the clinical care of individuals with Substance Use Disorders (SUDs). Methods: We used the Semi-Structured Assessment for Drug Dependence and Alcoholism to evaluate the lifetime presence of DSM-IV abuse and dependence diagnoses and DSM-5 mild, moderate, or severe SUDs for alcohol, cocaine, opioids, and cannabis in a sample of 7,543 individuals recruited to participate in genetic studies of substance dependence. Results: Switches between diagnostic systems consistently resulted in a modestly greater prevalence for DSM-5 SUDs, based largely on the assignment of DSM-5 diagnoses to DSM-IV diagnostic orphans (i.e, individuals meeting one or two criteria for dependence and none for abuse, and thus not receiving a DSM-IV SUD diagnosis). The vast majority of these diagnostic switches were attributable to the requirement that only two of 11 criteria be met for a DSM-5 SUD diagnosis. We found evidence to support the omission from DSM-5 of the legal criterion due to its limited diagnostic utility. The addition of craving as a criterion in DSM-5 did not substantially affect the likelihood of an SUD diagnosis. Conclusion: The greatest advantage of DSM-5 for the diagnosis of SUDs appears to be its ability to capture diagnostic orphans. In this sample, changes reflected in DSM-5 had a minimal impact on the prevalence of SUD diagnoses. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
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