The DSM-IV field trial for substance use disorders: major results

Despite increasing prevalence of nonmedical ketamine use globally, data on ketamine use disorders, which are classified in the DSM-5 under criteria for phencyclidine, are limited. This study assessed the reliability and applicability of DSM-based diagnostic criteria for ketamine use disorder.

Participants who used ecstasy were recruited through the Tri-City Study of Club Drug Use, Abuse, and Dependence in St. Louis, Miami, and Sydney. Those who reported using ketamine (lifetime use >5 times) were included in these analyses (n = 205). Participants were interviewed using the computerized Substance Abuse Module for Club Drugs (CD-SAM) at baseline and 7 days later for the reliability of diagnoses and individual diagnostic criteria.

Overall, 29.3% met DSM-5 adopted criteria for ketamine use disorder at Time 1. Moderate to excellent test-retest reliability was observed consistently across study sites for any ketamine use disorder (κ = 0.57, Y = 0.61) and severe ketamine use disorder (κ = 0.62, Y = 0.79). Continued use of ketamine despite knowledge of physical or psychological problems was the most frequently endorsed individual criterion (59.0%), followed by reported withdrawal (30.2%) and physically hazardous use (29.8%). All individual criteria had acceptable reliability estimates (κ ≥ 0.41).

Diagnoses of ketamine use disorder can be reliably evaluated using this fully structured diagnostic instrument’s questions and algorithm. Ketamine-related withdrawal among people who use ketamine should be re-evaluated. Considering that after-effects of this dissociative anesthetic can last for many hours, it is important to explore a different timeframe for possible withdrawal effects.

The proposed ICD-11 classification includes major revisions of alcohol dependence. We aimed to evaluate the presence of, and concordance between the proposed ICD-11 dependence and ICD-10, DSM-5, DSM-IV, DSM-III-R and DSM-III in a general population. We also examine as aspects of validity, including longitudinal stability and how meaningful clinical correlates associated across the systems.

Longitudinal population-based study of women in Gothenburg, Sweden. Participants (n = 1,614) were sampled during 1989–2015 through double-phase stratified random sampling. Alcohol use disorders were assessed through structured diagnostic interviews (CIDI-SAM), at baseline and follow-up 5–10 years later (n = 930). Concordance was examined using contingency tables and Cohen’s kappa coefficient.

At baseline, the prevalence of lifetime alcohol dependence was 10.6 % according to ICD-11. Corresponding figures were ICD-10, 4.0 %; DSM-IV, 4.3 %; DSM-III-R, 7.5 %; and DSM-III, 12.3 %.DSM-5 Alcohol Use Disorder was 14.3 %. Concordance between ICD-11 and other diagnoses ranged from almost perfect agreement (with DSM-5 AUD) to substantial (with DSM-III and DSM-III-R) and moderate (with ICD-10 and DSM-IV). The broadening of the “persistent use despite problems” criteria in ICD-11 had little effect on the prevalence. ICD-11 captured a lower proportion of family history of alcohol problems and treatment-seeking compared to ICD-10 and DSM-IV and showed lower stability.

The proposed ICD-11 algorithm yields a higher prevalence than either ICD-10 or DSM-III-R /-IV dependence, as well as lower agreement with previous diagnostic systems, lower longitudinal stability and weaker associations with clinical correlates. This is important for knowing how changes in diagnostic criteria impact prevalence estimates and related research.

We sought to describe the prevalence of the nonmedical use of prescription opioids (NMUPO) and its association with co-occurring substance use disorders in a sample of adolescents in substance treatment.

Adolescents in two substance treatment programs were recruited for participation between 2009 and 2013. The Composite International Diagnostic Interview—Substance Abuse Module (CIDI-SAM) was administered to assess substance use patterns and lifetime abuse or dependence.

A total of 378 adolescents completed the CIDI-SAM (mean age 16.1 [standard deviation = 1.1], 78% male, 50% white, non-Hispanic). Of the 378 adolescents, 62 (16.4%) reported NMUPO and 59 (15.6%) were diagnosed with opioid/heroin abuse or dependence. The mean age at first NMUPO was 14.3 (standard deviation = 1.4). NMUPO was associated with a 3.31-fold (95% confidence interval: 2.83–3.79) increase in having three or more co-occurring substance use diagnoses.

NMUPO is quite prevalent among adolescents in substance use treatment. Intervention to interrupt NMUPO from progressing to heroin use or developing into a disorder is critical.

Field trials of diagnostic classification systems can be divided into two types: developmental field trials, which are designed to collect performance data from users during the revision process, and summative field trials, which aim to assess what users can expect in terms of the classification's psychometric properties after the classification has been completed. A crucial component of an empirically guided diagnostic revision process is the use of developmental field trials in which data are collected from users regarding the feasibility, reliability, validity, and clinical utility of proposed changes that can assist in refining the proposals before they are finalised. The DSM-III and ICD-10 reliability field trials are best considered summative as they were done primarily to establish whether clinicians using operationalised definitions could achieve adequate diagnostic reliability. The DSM-III-R and DSM-IV field trials, which collected performance data targeting specific diagnostic categories, heralded the use of developmental field trial data as an important component in the construction of diagnostic criteria sets, a process being continued in the ICD-11 revision process. Although initially presented as developmental in nature, the DSM-5 field trials ended up being essentially summative. Although reliability estimates with highly sophisticated methodology were provided for 23 mental disorders, the absence of information regarding the reliability of specific diagnostic items and the reasons for diagnostic disagreement prevented this information from being used to address identified reliability issues. Developmental field trials enhance the empirical basis for stating that psychiatric classifications are evidence based and they ultimately contribute to the improvement of clinical care for patients.

There is little prospective-epidemiological information on symptoms of DSM-IV-alcohol use disorder (alcohol abuse and dependence; AUD) that may be typical for early AUD stages or the developmental periods of adolescence and early adulthood.

To investigate AUD symptoms (AUDS) cross-sectionally at three subsequent assessment waves regarding prevalence rates, symptom counts, associated drinking patterns, positive predictive values (PPV) for DSM-IV-alcohol dependence (AD), and AUDS stability over time.

N = 2039 community subjects (baseline age 14–24 years) participated in a baseline and two follow-up assessment(s) over up to ten years. DSM-IV-AUDS, DSM-IV-AUD and craving were assessed with the DSM-IV/M-CIDI.

Over the assessment waves, tolerance and much time were most and role obligations and withdrawal least frequent. Most subjects with DSM-IV-AUDS reported only one symptom (47.2–55.1%). PPV for DSM-IV-AD only exceeded 70% for activities, problem, withdrawal, and desired control; PPV were lowest for tolerance and hazardous use. For most AUDS, AUDS report compared to non-report was associated with elevated drinking frequency and amounts. Stability of baseline AUDS at four-year and ten-year follow-up did not exceed 36.4% for any symptom.

The overall pattern of most/least frequent AUDS reported in adolescence and early adulthood resembles findings in older adults and does not suggest a developmentally specific symptom pattern. Moderate AUDS-stability and considerable remission rates indicate that AUDS in this age group are transient for a considerable proportion of subjects. However, the associations with elevated consumption indicate that AUDS reports early in life need to be taken seriously in prevention and intervention.