Diagnostic implications of craving in assessing disorders for commonly-abused substances

Background. The Diagnostic and Statistical Manual of Mental Disorders (DSM-I) was published by the American Psychiatric Association in 1952. DSM-II was published in 1968; DSM-III in 1980; DSM-III-R in 1987; DSM-IV in 1994; and DSM-IV-TR in 2000. DSM-5, the next major revision, is scheduled for 2013. DSM-5 will combine the categories of substance abuse and substance dependence into “substance use disorders” and feature craving, strong desire, or urge as criteria for diagnosis. Nearly 2,500 articles have been published on substance use disorders and craving for alcohol, cocaine, heroin, marijuana, methamphetamine, and tobacco. This study systematically reviewed literature on historical and current developments regarding the utility of craving in diagnosing substance use disorders.

Methods. Raters content analyzed the abstracts to identify relevant articles by disorder (reliability was established on 10 abstracts). Relevant articles were fully content analyzed. Articles were extracted for diagnosis criteria and conclusions related to diagnosis and craving for each disorder separately.

Results. A study flow diagram (number of abstracts reviewed, number articles fully reviewed) by substance. A series of mini-reviews indicated global and local criteria regarding the utility of craving in the diagnosis for each substance use disorder, separately. Conclusions. Findings suggest that historical and contemporary developments in global diagnostic criteria can ultimately affect local mental health practice. Implications for local mental health practice are discussed.