Analyses related to the development of DSM-5 criteria for substance use related disorders: 1. Toward amphetamine, cocaine and prescription drug use disorder continua using Item Response Theory

Abstract

Background: Prior research has demonstrated the dimensionality of alcohol, nicotine and cannabis use disorders criteria. The purpose of this study was to examine the unidimensionality of DSM-IV cocaine, amphetamine and prescription drug abuse and dependence criteria and to determine the impact of elimination of the legal problems criterion on the information value of the aggregate criteria.

Methods: Factor analyses and Item Response Theory (IRT) analyses were used to explore the unidimensionality and psychometric properties of the illicit drug use criteria using a large representative sample of the U.S. population.

Results: All illicit drug abuse and dependence criteria formed unidimensional latent traits. For amphetamines, cocaine, sedatives, tranquilizers and opioids, IRT models fit better for models without legal problems criterion than models with legal problems criterion and there were no differences in the information value of the IRT models with and without the legal problems criterion, supporting the elimination of that criterion.

Conclusion: Consistent with findings for alcohol, nicotine and cannabis, amphetamine, cocaine, sedative, tranquilizer and opioid abuse and dependence criteria reflect underlying unitary dimensions of severity. The legal problems criterion associated with each of these substance use disorders can be eliminated with no loss in informational value and an advantage of parsimony. Taken together, these findings support the changes to substance use disorder diagnoses recommended by the American Psychiatric Association's DSM-5 Substance and Related Disorders Workgroup.

Figure 1

Figure 1a. Criterion Response Curves: Amphetamines Tolerance Withdrawal Larger/longer Quit/control Time spent Activities given up Physical/psychological Neglect roles Hazardous use Social/interpersonal Legal Problems Figure 1b. Criterion Response Curves: Cocaine Tolerance Withdrawal Larger/longer Quit/control Time spent Activities given up Physical/psychological Neglect roles Hazardous use Social/interpersonal Legal Problems

Figure 2

Figure 2a. Criterion Response Curves: Sedatives Tolerance Withdrawal Larger/longer Quit/control Time spent Activities given up Physical/psychological Neglect roles Hazardous use Social/interpersonal Legal Problems Figure 2b. Criterion Response Curves: Tranquilizers Tolerance Withdrawal Larger/longer Quit/control Time spent Activities given up Physical/psychological Neglect roles Hazardous use Social/interpersonal Legal Problems Figure 2c. Criterion Response Curves: Opioids Tolerance Withdrawal Larger/longer Quit/control Time spent Activities given up Physical/psychological Neglect roles Hazardous use Social/interpersonal Legal Problems