'Diagnostic orphans' among young adult cannabis users: persons who report dependence symptoms but do not meet diagnostic criteria

Drug Alcohol Depend. 2002 Jul 1;67(2):205-12. doi: 10.1016/s0376-8716(02)00064-9.

Abstract

Objective: To examine the characteristics of 'diagnostic orphans' among cannabis users-those who report one or two symptoms of DSM-IV dependence but do not meet diagnostic criteria for DSM-IV abuse or dependence.

Method: Data were collected from a representative population cohort of 1601 young adults aged 20-21 years. Those who reported that they had used cannabis at least weekly at some point within the past year were assessed for symptoms of DSM-IV cannabis abuse and dependence using the Composite International Diagnostic Interview.

Results: Approximately 2.8% of the cohort could be classified as diagnostic orphans, with another 3.0 and 7.5% meeting criteria for abuse and dependence, respectively. Diagnostic orphans were: similar to those who met criteria for cannabis abuse or dependence in terms of demographic characteristics; similar to those who met criteria for cannabis abuse in terms of cannabis use patterns; and similar to those who met criteria for abuse and dependence in their rates of heavy alcohol use and DSM-IV alcohol dependence. However, they did not appear to have elevated rates of illicit drug use or mental health problems compared to non users.

Conclusions: Diagnostic orphans reported using cannabis in a manner similar to persons meeting criteria for cannabis abuse, and had similar rates of alcohol dependence and other illicit drug use. Strict adherence to DSM-IV diagnoses of abuse and dependence may overlook a substantial proportion of young persons who experience cannabis-related problems. There is a need to consider (a) subthreshold levels of cannabis-related problems among those seeking treatment for other problems; and (b) interventions for this group to prevent escalation of such problems.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Age Factors
  • Confidence Intervals
  • Female
  • Humans
  • Logistic Models
  • Male
  • Marijuana Abuse / diagnosis*
  • Marijuana Abuse / epidemiology*
  • Marijuana Abuse / psychology
  • Marijuana Smoking / epidemiology*
  • Marijuana Smoking / psychology
  • Odds Ratio
  • Psychiatric Status Rating Scales