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. 2013 Aug;170(8):834-51.
doi: 10.1176/appi.ajp.2013.12060782.

DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale

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DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale

Deborah S Hasin et al. Am J Psychiatry. .
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Since DSM-IV was published in 1994, its approach to substance use disorders has come under scrutiny. Strengths were identified (notably, reliability and validity of dependence), but concerns have also arisen. The DSM-5 Substance-Related Disorders Work Group considered these issues and recommended revisions for DSM-5. General concerns included whether to retain the division into two main disorders (dependence and abuse), whether substance use disorder criteria should be added or removed, and whether an appropriate substance use disorder severity indicator could be identified. Specific issues included possible addition of withdrawal syndromes for several substances, alignment of nicotine criteria with those for other substances, addition of biomarkers, and inclusion of nonsubstance, behavioral addictions.This article presents the major issues and evidence considered by the work group, which included literature reviews and extensive new data analyses. The work group recommendations for DSM-5 revisions included combining abuse and dependence criteria into a single substance use disorder based on consistent findings from over 200,000 study participants, dropping legal problems and adding craving as criteria, adding cannabis and caffeine withdrawal syndromes, aligning tobacco use disorder criteria with other substance use disorders, and moving gambling disorders to the chapter formerly reserved for substance-related disorders. The proposed changes overcome many problems, while further studies will be needed to address issues for which less data were available.

Conflict of interest statement

The other authors report no financial relationships with commercial interests.


FIGURE 1. DSM-IV and DSM-5 Criteria for Substance Use Disorders
a One or more abuse criteria within a 12-month period and no dependence diagnosis; applicable to all substances except nicotine, for which DSM-IV abuse criteria were not given. b Three or more dependence criteria within a 12-month period. c Two or more substance use disorder criteria within a 12-month period. d Withdrawal not included for cannabis, inhalant, and hallucinogen disorders in DSM-IV. Cannabis withdrawal added in DSM-5.
FIGURE 2. Information Characteristic Curves from Item Response Theory Analysis of DSM-IV Alcohol Abuse and Dependence Criteria, Required to Persist Across 3 Years of Follow-Upa,b
a Red curves: DSM-IV abuse criteria. Black curves: DSM-IV dependence criteria. Blue curve: Craving. b Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), Wave 2 (2004–2005), conducted by the National Institute on Alcohol Abuse and Alcoholism. Participants were noninstitutionalized civilians age 20 years and older (N=34,653). The NESARC had a multistage design and oversampled blacks, Hispanics, and young adults. Analyses were conducted with Mplus (version 6.12, Los Angeles, Muthén & Muthén, 2011) and incorporated sample weights to adjust standard errors appropriately. See supplementary Table S2 for more detail on this analysis.

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