How should we revise diagnostic criteria for substance use disorders in the DSM-V?

Martin, Christopher S.; Chung, Tammy; Langenbucher, James

doi:10.1037/0021-843x.117.3.561

Cited by 159 publications

(126 citation statements)

References 128 publications

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“…First, DSM-IV lifetime diagnostic criteria may exclude individuals with a history of extensive dependence symptomatology that is relevant for case conceptualization and treatment planning. Second, the diagnostic value of the lifetime abuse category, absent of dependence symptomatology, to differentiate individuals on overall functioning and problematic alcohol involvement may be limited, and the current fi ndings are consistent with increasing criticism of the validity of the abuse construct (e.g., Martin et al, 2008). Third, the fi nding that orphan groups without abuse demonstrated equivalent gender composition suggests that both sexes are at equal risk to experience dependence symptoms that are not clustered within a 12-month period.…”

Section: Discussionsupporting

confidence: 63%

Three (or More) Alcohol-Dependence Symptoms but Not Clustered in the Same 12 Months: Diagnostic Orphans From a Longitudinal Perspective

Littlefield¹,

Vergés²,

Sher³

2010

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), currently uses a polythetic classifi cation system for defi ning alcohol use disorders (AUD; alcohol abuse and dependence). This classifi cation results in individuals who are subthreshold for an offi cial AUD diagnosis but still endorse one or two criteria of dependence: so-called "diagnostic orphans." To our knowledge, however, there has been no attention given to diagnostic orphans from a lifetime perspective. The goal of the current article was to compare various diagnostic groups based on lifetime reports of abuse and dependence symptoms on a range of outcomes. Method: Data taken from the National Epidemiological Survey of Alcohol and Related Conditions study were used to form seven mutually exclusive diagnostic groups based on lifetime abuse and dependence symptomatology. Results:Diagnostic groups that experienced extensive dependence symptoms, regardless of past-12-month clustering (i.e., formal diagnostic criteria), tended to exhibit poorer outcomes compared with participants that met formal lifetime diagnosis for an AUD through abuse alone. It is notable that a signifi cant group of individuals who failed to meet formal lifetime AUD diagnosis, but who endorsed a number of dependence symptoms, consistently demonstrated more problematic outcomes on a range of measures compared with individuals who never reported dependence symptoms but who were formally diagnosed with lifetime AUD through alcohol abuse. Conclusions: DSM-IV lifetime diagnostic criteria may exclude individuals with a history of extensive dependence symptomatology. Implications regarding lifetime diagnosis conceptualization are discussed. (J. Stud. Alcohol Drugs, 71, 864-869, 2010)

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Section: Discussionsupporting

confidence: 63%

Three (or More) Alcohol-Dependence Symptoms but Not Clustered in the Same 12 Months: Diagnostic Orphans From a Longitudinal Perspective

Littlefield¹,

Vergés²,

Sher³

2010

J. Stud. Alcohol Drugs

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“…One potential way to revise tolerance is to assign the symptom when substance use is sufficiently heavy to infer physiologic adaptation to its acute effects, even if a person do not endorse the change-based components of the symptom. Particularly for alcohol, may be useful the blood alcohol concentration (BAC) as a method to evaluate a degree of tolerance (Martin, Chung, & Langenbucher, 2008). Moreover, epidemiologist and clinicians need to be more cautions of the tendency of structured interviews to classify adolescents as being alcohol dependent (Caetano & Babor, 2006).…”

Section: Discussionmentioning

confidence: 99%

Gender differences in the prevalence of DSM-IV alcohol use disorders in adolescents

Secades‐Villa

López-Núñez²,

Fernández-Artamendi³

et al. 2013

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Resumen AbstractDespite the availability of data about drinking frequency and patterns, the surveys on alcohol use among adolescents carried out in Europe tend not to provide information about diagnostic criteria for alcohol use disorders (AUD) or estimation of their prevalence. This study assesses the prevalence of AUD among a sample of Spanish adolescents, to identify the most prevalent symptoms, and explore gender differences in AUD in this population. The final sample consisted of 504 participants aged 15 to 18, obtained by means of random sampling from all the schools in the region of Asturias (Spain). The presence of alcohol abuse (AA) and alcohol dependence (AD) disorders was evaluated according to DSM-IV-TR criteria. The results showed that 12.5% of the sample met the criteria for the diagnosis of AUD (6.7% for alcohol abuse, AA, and 5.8% for alcohol dependence, AD). The most prevalent symptoms were having social problems for AA diagnosis (9% of students who reported alcohol use in the past year) and tolerance for AD diagnosis (45.8% of students who reported alcohol use in the past year). Males showed a significantly higher score than females in AUD, AA and two AA diagnosis criteria (hazardous use and legal problems). The prevalence of AUD among Spanish adolescents is very high, males being more likely than females to endorse criteria for AUD and AA, though not for AD. These findings reveal a serious health issue and highlight the need to develop preventive efforts and provide coordinated alcohol-abuse interventions.Key words: adolescents, alcohol use disorders, alcohol abuse, alcohol dependence, gender differences.Las encuestas sobre el uso de alcohol en los adolescentes en Europa no suelen proporcionar información sobre los criterios para el diagnóstico de trastornos por uso alcohol (TUA) o la prevalencia de dichos trastornos.En este estudio se valora la prevalencia de TUA en una muestra de adolescentes españoles, y se identifican los síntomas más prevalentes, así como las diferencias de género en TUA en esta población. La muestra estuvo compuesta por 504 participantes de entre 15 y 18 años. Se realizó un muestreo al azar de todas las escuelas del Principado de Asturias (España).La presencia de abuso de alcohol (AA) y la dependencia del alcohol (DA) fue evaluada según el DSM-IV-TR. Los resultados mostraron que el 12,5% de la muestra cumplía criterios para el diagnóstico de TUA (6,7% AA y 5,8% DA). Los síntomas más frecuentes fueron tener problemas sociales para el diagnóstico de AA (9% de los participantes que habían bebido en el último año) y tolerancia para el diagnóstico de DA (45,8% de los participantes que habían bebido en el último año). Los varones mostraron una puntuación significativamente más alta que las mujeres en TUA, AA y dos criterios de AA (consumo imprudente y problemas legales). La prevalencia de TUA en los adolescentes españoles es muy alta. Los varones son más propensos que las mujeres a cumplir criterios de TUA y AA, aunque no de DA. Estos hallazgos revelan un problema de salud gra...

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“…Face-to-face interviews were conducted with 43,093 adults (response rate, 81%), aged 18 years and older from the civilian non-institutionalized population residing in the United States, including the District of Columbia, Hawaii, and Alaska. The NESARC sample was weighted to adjust for probabilities of selection of a sample housing unit or housing unit equivalent, the non-response at the household and person levels, the selection of one person per household, and the over sampling of African Americans, Hispanics, and young adults (ages [18][19][20][21][22][23][24]. The weighted data were post-stratified and adjusted to match the target population based on the 2000 decennial census in terms of region, age, sex, race, and ethnicity.…”

Section: Data Sourcementioning

confidence: 99%

“…22,23 A single SUDs criteria set is currently proposed for the fifth edition of the DSM. 24 Diagnosis of substance abuse may be particularly important when exploring gender differences as it is partially reflective of context of substance use, which differs greatly between genders. For instance, examples of abuse criteria in the DSM-IV include criteria such as being engaged in physical fights or operating heavy machinery under the influence of a substance, which females may be less likely to identify with.…”

Section: Introductionmentioning

confidence: 99%

Gender Differences in Prevalence of Substance Use Disorders among Individuals with Lifetime Exposure to Substances: Results from a Large Representative Sample

et al. 2013

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Background and ObjectivesResearch regarding substance use and substance use disorders (SUDs) shows significant gender differences in prevalence of substance use and dependence. Though lifetime exposure to substances is higher among males, previous reports have not regarded gender differences in prevalence of SUDs among individuals formerly exposed to substances. In addition, though substance abuse is particularly important when exploring gender differences, previous reports have largely focused on rates of transition to substance dependence alone. In this study, we explored gender differences in prevalence of SUDs among individuals with lifetime exposure to substances using a single diagnostic category (abuse or dependence).MethodsWe analyzed 11 different categories of substances: heroin, cocaine, cannabis, nicotine, alcohol, hallucinogens, inhalants, sedatives, tranquilizers, opioids, and amphetamines. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1, n = 43,093). The impact of gender on prevalence of SUDs among individuals with lifetime exposure to substances was assessed with odds ratios (ORs) using logistic regressions and adjusted for socio‐demographic factors.ResultsOur results show that among individuals with lifetime exposure to substances, males had a significantly higher prevalence of alcohol (OR = 2.95), sedatives (OR = 2.00), cannabis (OR = 1.93), tranquilizers (OR = 1.64), opioids (OR = 1.54), hallucinogens (OR = 1.31), and cocaine (OR = 1.26) use disorders compared with females.Conclusions and Scientific SignificanceUsing a single broad diagnostic category highlights gender differences in the prevalence of SUDs among individuals with former exposure to substances. Specifically, the significant gender differences found for alcohol, sedatives, and cannabis use disorders may be important for tailoring preventive measures targeted at reducing rates of SUDs among males using these substances. (Am J Addict 2012;XX:000–000) (Am J Addict 2013;22:7‐13)

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How should we revise diagnostic criteria for substance use disorders in the DSM-V?

Cited by 159 publications

References 128 publications

Three (or More) Alcohol-Dependence Symptoms but Not Clustered in the Same 12 Months: Diagnostic Orphans From a Longitudinal Perspective

Three (or More) Alcohol-Dependence Symptoms but Not Clustered in the Same 12 Months: Diagnostic Orphans From a Longitudinal Perspective

Gender differences in the prevalence of DSM-IV alcohol use disorders in adolescents

Gender Differences in Prevalence of Substance Use Disorders among Individuals with Lifetime Exposure to Substances: Results from a Large Representative Sample

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