Classifying opioid use disorder based on diagnostic criteria items using cluster analysis

Abstract

Background: Opioid use disorder (OUD) is a global concern with a reported shift in changing demographic and biopsychosocial profiles. Characterization of clusters based on diagnostic symptom criteria can help to understand the underlying associations between these criteria.

Aim: The present study identifies clusters based on OUD diagnostic criteria, which may reveal clinically relevant subgroups of individuals with OUDs.

Materials and methods: The DSM5 diagnostic system OUD diagnosis was made for 204 male participants. An unsupervised clustering analysis focused on the individual 11 DSM5 diagnostic criteria.

Results: Using the DSM5 diagnostic criteria, we obtained two clusters based on severity. Further, analyzing clinical information along with DSM5 criteria, two groups varying in OUD severity, presence of injecting drug use, and employment were identified.

Conclusion: Based on cluster analysis, two main clusters of DSM5 criteria emerged. Rather than DSM5 symptoms clustering with each other based on the similarity of symptomatology, they aggregate numerically reflecting severity.

Keywords: Clinical relevance; Diagnostic and Statistical Manual of Mental Disorders; cluster analysis; opioid-related disorders; phenotype.

Figure 1

Frequency of DSM5 criteria for opioid use disorder. DSM_Tolerance-Tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount, DSM_Withdrawal-Withdrawal manifesting as either a characteristic syndrome or the substance is used to avoid withdrawal, DSM_IncreasedUse-Taken in larger amounts or longer period than intended, DSM_InabilityToCutDown-Persistent desire or unsuccessful efforts to cut down or control substance use, Time - A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects, DSM_Craving-Craving or a strong desire to use substances, DSM_ObligationsNotFulfilled-Substance use resulting in a failure to fulfill major role obligations at work, school, or home, DSM_SocialInterpersonalIssues-Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance, DSM_ReducedActivities Stopping or reducing important social, occupational, or recreational activities due to substance use, DSM_UseinHazardousSituation-Recurrent use of substances in physically hazardous situations, DSM_PersistentPhysicalPsychologicalDifficulties- The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the use of the substance.

Figure 2

Relationship of DSM criteria. (a) Heatmap showing the correlation/association among DSM5 criteria [*Significant at 0.05 significance level (2-tailed)]. (b) Network map showing strongest associations among DSM5 criteria. DSM_Tolerance-Tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount, DSM_Withdrawal-Withdrawal manifesting as either a characteristic syndrome or the substance is used to avoid withdrawal, DSM_IncreasedUse-Taken in larger amounts or longer period than intended, DSM_InabilityToCutDown-Persistent desire or unsuccessful efforts to cut down or control substance use, DSM_Time- A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects, DSM_Craving-Craving or a strong desire to use substances, DSM_ObligationsNotFulfilled-Substance use resulting in a failure to fulfill major role obligations at work, school, or home, DSM_SocialInterpersonalIssues-Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance, DSM_ReducedActivities Stopping or reducing important social, occupational, or recreational activities due to substance use, DSM_UseinHazardousSituation-Recurrent use of substances in physically hazardous situations, DSM_PersistentPhysicalPsychologicalDifficulties-The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the use of the substance