Modeling of Lifetime Sedative, Tranquilizer and Opioid Use Disorders using Item Response Theory

This study examined the psychometric properties and factor structures of DSM-IV criteria for sedative, tranquilizer, and opioid use disorders and explored the invariance of drug use disorder criteria across gender, age and race-ethnicity. Item response theory (IRT) was used to determine whether DSM-IV criteria were arrayed along a continuum of severity. Data for this study come from a large nationally representative sample of the US adult population. Exploratory factor analysis showed a single strong common dimension of all DSM-IV 11 drug abuse and dependence criteria. A two-parameter logistic IRT model was used to determine the severity and discrimination of each DSM –IV criteria. The results from IRT analyses showed that all DSM –IV abuse and dependence criteria for sedatives, tranquilizer and opioids formed a continuum of drug use disorder severity. The criteria response curves (CRCs) associated with each drug were quite similar in terms of relative severity of drug use disorder, with dependence criteria quit/control falling the along the least severe of the disorder and abuse criteria legal problems as being in the severe range of the continuum. These findings do not support the frequent assumption that abuse is prodromal to dependence. However, the dense clustering for severity and discrimination with tolerance, time spent, neglect roles and hazardous use suggest that these criteria produce the same information on case severity. Further, there was no evidence of differential criterion functioning, indicating the invariance across sex, age, and race-ethnic subgroups of the population.