234987 Revised criteria for DSM-V substance use disorders

Monday, October 31, 2011: 1:10 PM

Bridget F. Grant, PhD, PhD , Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
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.

Learning Areas:
Basic medical science applied in public health
Clinical medicine applied in public health
Public health or related research

Learning Objectives:
Describe the major evidence-based revisions to the classification of substance use disorders under DSM-V. Explain the basis for use of simple symptom counts as a measure of the clinical severity of substance use disorders.

Keywords: Alcoholism, Substance Abuse

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My work over the last 20 years has focused on the development and implementation of state-of-the-art research methods in the study of the epidemiology and nosology of alchohol, drug and mental disorders. I have also participated in the development of the DSM-IIIR, DSM-IV, and ICD-10 classifications of alcohol, drug, and mental disorders. Currently I am the principal investigator of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), findings from which have provided a substantial proportion of the evidence base supporting changes proposed for substance use disorder diagnoses in DSM-V. In addition, I serve as a member of the DSM-V Task force, the Diagnostic Assessment Instruments Study Group, and the Substance-Related Disorders Workgroup of the American Psychiatric Association.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.