Nosologic Comparisons of DSM-IV and DSM-5 Alcohol and Drug Use Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions–III

Abstract

ABSTRACT. Objective: The purpose of this study was to examine prevalences and concordances between Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and Fifth Edition (DSM-5) substance use disorders (SUDs) in a newly completed U.S. epidemiologic survey. Method: The National Epidemiologic Survey on Alcohol and Related Conditions-III surveyed 36,309 civilian, noninstitutionalized adults. SUDs were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Concordances between DSM-IV and DSM-5 disorders were assessed using kappa statistics. Results: Prevalences of past-year substance-specific DSM-5 disorders (2+ criteria) were modestly higher than those of DSM-IV dependence and abuse combined for alcohol, sedatives/ tranquilizers, opioids, and heroin, but lower for cannabis, cocaine, and stimulants. Lifetime prevalences were lower under DSM-5. Prevalences were similar between moderate to severe (4+ criteria) DSM-5 disorders and dependence, whereas prevalences of DSM-5 disorders at 3+ criteria (DSM-5 [3+]) were higher, particularly for cannabis. Past-year concordances were excellent for DSM-IV dependence and abuse combined versus any DSM-5 and DSM-IV dependence versus DSM-5 moderate to severe disorders; lifetime concordances were fair to excellent. Past-year concordances between DSM-IV and DSM-5 (3+) were generally similar to or modestly higher than those with any DSM-5 disorder; lifetime concordances were mostly lower. Conclusions: Findings are consistent with those informing the development of DSM-5. Future research should examine differences in patterns between past-year and lifetime disorders, particularly for cannabis. Other questions warranting investigation include whether different combinations of the same numbers of criteria carry different clinical or nosologic implications, whether changes in nosology yield changes in treatment demand, and whether changes in characteristics of individuals with DSM-5 SUDs dictate modifications to screening and intervention. (J. Stud. Alcohol Drugs, 76, 378-388, 2015)

A Cross‐National Examination of Differences in Classification of Lifetime Alcohol Use Disorder Between DSM‐IV and DSM‐5: Findings from the World Mental Health Survey

“…The Mewton and colleagues study (2011) assessed each and every symptom criterion in the 12 months prior to interview and showed an increase in the prevalence of AUD under DSM‐5 compared with DSM‐IV, whereas the current study employed a lifetime time frame and showed a slight decrease. It is notable that this pattern of findings is similar to that shown in a recent nosologic comparison of DSM‐IV and DSM‐5 alcohol and drug use disorders using data from the National Epidemiologic Survey on Alcohol and Related Conditions‐III (Goldstein et al., ). Recent research summarizing AUD symptom severity (derived through item response theory) across 34 previously published studies concluded that variability in the diagnostic instruments employed was the biggest contributor to low consistency in the rank ordering of AUD criteria severity (Lane et al., ).…”

Greater Prevalence of Proposed ICD-11 Alcohol and Cannabis Dependence Compared to ICD-10, DSM-IV, and DSM-5 in Treated Adolescents

“…Comparisons of prevalence rates according to different diagnostic systems were conducted using McNemar tests of correlated proportions. Specifically, as concordance between DSM‐IV dependence and DSM‐5 SUD was maximized for alcohol when using ≥ 4 DSM‐5 SUD criteria (Compton et al., ; Goldstein et al., ), McNemar tests of correlated proportions were used to compare DSM‐IV, ICD‐10, and ICD‐11 dependence against DSM‐5 M/S use disorder (≥ 4 criteria). Exploratory comparisons of diagnostic groupings on frequency of substance use and symptom count were conducted using analysis of covariance, controlling for age and gender.…”

“…Prevalence of diagnoses and symptoms, and diagnostic concordance across the classification systems were examined. Due to the substantial changes proposed for ICD‐11 dependence, and that ICD‐11 and DSM‐5 may be used concurrently, we examined prevalence and concordance of proposed ICD‐11 dependence and DSM‐5 M/S (DSM‐5 M/S is generally considered to be comparable to DSM‐IV dependence; Compton et al., ; Goldstein et al., ). We also identified sources of diagnostic switching (i.e., “loss” or “gain” of diagnostic status) for DSM‐5 M/S and proposed ICD‐11 dependence to determine sources of diagnostic disagreement.…”

Cannabis and alcohol use, affect and impulsivity in psychiatric out-patients' daily lives

“…Cannabis is the most commonly used illicit drug world‐wide , and there is great controversy over the relative benefits versus adverse effects of its use . Two important factors involved in cannabis use are affect and impulsivity, both of which are implicated in theories of substance use and abuse.…”