234988 Nicotine use disorders in DSM-V

Monday, October 31, 2011: 3:10 PM

Deborah S. Hasin, PhD , Columbia University/New York State Psychiatric Institute, New York, NY
Evidence-based changes planned for DSM-5 substance use disorders (SUDs) include combining dependence and three of the abuse criteria into one disorder and adding a criterion indicating craving. DSM-IV did not include a category for nicotine abuse, but data were found to help the DSM-5 Substance Disorders Workgroup evaluate whether aligning the nicotine use disorder criteria with the other substances in DSM-5 had empirical support. Item response theory and other types of analyses were conducted in U.S. and Israeli general population data to determine the advisability of these changes in the criteria for nicotine use disorder. When dependence criteria only were examined, they formed a unidimensional structure. Adding the three abuse criteria and craving maintained this unidimensionality, with abuse and dependence criteria arrayed across the severity spectrum. Statistical tests indicated that the addition of the abuse criteria significantly increased the amount of information available compared to a criteria set consisting of nicotine dependence only. Strong associations with clinically relevant covariates (level of smoking, smoking shortly after awakening) further supported the combination of nicotine dependence, abuse, and craving criteria as a dimension representing a single nicotine use disorder. Based on this evidence, the DSM-5 Substance Disorders Workgroup has proposed aligning the DSM-5 criteria for nicotine use disorders with the criteria for the other substance use disorders.

Learning Areas:
Public health or related research

Learning Objectives:
Describe changes planned for DSM-V as related to the diagnosis of nicotine use disorder. Explain at least two aspects of the evidence base supporting the planned changes to the diagnostic criteria.

Keywords: Tobacco, Substance Abuse

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been conducting state-of-the-science substantive and methodologic research both in the U.S. and internationally on alcohol and other substance use and associated disorders for over 25 years. My research activities include studies of the epidemiology, natural history, and course of alcohol, drug, nicotine, and other psychiatric disorders, many of which have contributed to the evidence base for the classification of substance use disorders in DSM-V. In addition, I have investigated the interaction of genetic and environmental influences on heavy drinking and alcohol dependence, and the development of innovative behavioral interventions to reduce risky substance use in HIV primary care and other clinical settings.
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.