Revised criteria for DSM-V substance use disorders

Major revisions for the DSM-V Substance Use and Pathological Gambling Chapter are to combine abuse and dependence symptoms into one diagnosis, determine how best to characterize the severity of the combined diagnoses, and determine the impact on diagnosis of eliminating the legal problems criterion. This presentation will focus on national and international studies, largely amassed from Item Response Theory analyses, that support combining the abuse and dependence categories, identifying the severity of disorder, and eliminating the legal problems criterion. This research has consistently shown that: (1) the combined DSM-IV abuse and dependence criteria map onto a single severity continuum for alcohol, cannabis, hallucinogens, cocaine, nicotine, sedatives, and tranquilizers, stimulants, and inhalants/solvents; (2) abuse does not appear prodromal to dependence; and (3) elimination of the legal problems criterion does not affect the information value of the substance use disorder diagnoses. Studies examining differential symptom or criterion functioning for the abuse and dependence items have found no differential functioning by sex, age or race-ethnicity. Several severity measures of substance use disorders were considered; major results will be presented on the use of symptom counts, symptom counts weighted by IRT severity parameters, and frequency-weighted symptom counts. Results from this new research indicate that simple symptom counts relate as closely to external validators, including measures of consumption, early-onset drinking, major depression and antisocial personality disorder, as the more complicated measures of severity assessed. These findings support the use of simple counts of substance use disorder criteria as a measure of severity of the disorders.