title: Abuse and dependence on prescription opioids in adults: a mixture categorical and dimensional approach to diagnostic classification.
abstract: BACKGROUND
  For the emerging DSM-V, it has been recommended that dimensional and categorical methods be used simultaneously in diagnostic classification; however, little is known about this combined approach for abuse and dependence.
  
  
  METHODS
  Using data (n=37 708) from the 2007 National Survey on Drug Use and Health (NSDUH), DSM-IV criteria for prescription opioid abuse and dependence among non-prescribed opioid users (n=3037) were examined using factor analysis (FA), latent class analysis (LCA, categorical), item response theory (IRT, dimensional), and factor mixture (hybrid) approaches.
  
  
  RESULTS
  A two-class factor mixture model (FMM) combining features of categorical latent classes and dimensional IRT estimates empirically fitted more parsimoniously to abuse and dependence criteria data than models from FA, LCA and IRT procedures respectively. This mixture model included a severely affected group (7%) with a comparatively moderate to high probability (0.32-0.88) of endorsing all abuse and dependence criteria items, and a less severely affected group (93%) with a low probability (0.003-0.16) of endorsing all criteria. The two empirically defined groups differed significantly in the pattern of non-prescribed opioid use, co-morbid major depression, and substance abuse treatment use.
  
  
  CONCLUSIONS
  A factor mixture model integrating categorical and dimensional features of classification fits better to DSM-IV criteria for prescription opioid abuse and dependence in adults than a categorical or dimensional approach. Research is needed to examine the utility of this mixture classification for substance use disorders and treatment response.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC 27710, USA. litzy.wu@duke.edu
authors.forename: L-T
authors.initials: LT
authors.lastname: Wu
authors.forename: G E
authors.initials: GE
authors.lastname: Woody
authors.forename: C
authors.initials: C
authors.lastname: Yang
authors.forename: J-J
authors.initials: JJ
authors.lastname: Pan
authors.forename: D G
authors.initials: DG
authors.lastname: Blazer
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009293:Opioid-Related Disorders / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology; D055553:Prescription Drugs; D015995:Prevalence; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D055553:Prescription Drugs
references.citation: Addiction. 1994 Sep;89(9):1105-13
references.pmid: 7987187
references.citation: Drug Alcohol Depend. 2008 Apr 1;94(1-3):1-11
references.pmid: 18054444
references.citation: Br J Psychiatry. 1987 Dec;151:834-43
references.pmid: 2901887
references.citation: Addiction. 1999 Jun;94(6):843-55
references.pmid: 10665074
references.citation: Int J Methods Psychiatr Res. 2007;16 Suppl 1:S24-33
references.pmid: 17623392
references.citation: Addict Behav. 2006 Jun;31(6):1050-66
references.pmid: 16675147
references.citation: Drug Alcohol Depend. 2006 Jan 4;81(1):21-6
references.pmid: 16005578
references.citation: Addiction. 1995 Dec;90(12):1661-9
references.pmid: 8555957
references.citation: J Am Acad Child Adolesc Psychiatry. 2008 Sep;47(9):1020-9
references.pmid: 18664996
references.citation: Drug Alcohol Depend. 2008 Nov 1;98(1-2):105-14
references.pmid: 18586414
references.citation: Addiction. 2007 Jun;102(6):920-30
references.pmid: 17523987
references.citation: Addiction. 2006 Sep;101 Suppl 1:6-16
references.pmid: 16930156
references.citation: Psychol Med. 2007 Sep;37(9):1345-55
references.pmid: 17407621
references.citation: Drug Alcohol Depend. 2002 Dec 1;68(3):255-62
references.pmid: 12393220
references.citation: J Am Acad Child Adolesc Psychiatry. 2009 May;48(5):563-572
references.pmid: 19318987
references.citation: Eur Arch Psychiatry Clin Neurosci. 2008 Nov;258 Suppl 5:2-6
references.pmid: 18985287
references.citation: Addict Behav. 2006 Jun;31(6):929-47
references.pmid: 16697532
references.citation: Drug Alcohol Depend. 2009 Aug 1;103(3):114-23
references.pmid: 19423244
references.citation: Pain Physician. 2007 May;10(3):399-424
references.pmid: 17525776
references.citation: Drug Alcohol Depend. 2003 Apr 1;69(3):215-32
references.pmid: 12633908
references.citation: J Abnorm Psychol. 2004 Feb;113(1):72-80
references.pmid: 14992659
references.citation: Science. 1998 May 8;280(5365):867-73
references.pmid: 9572724
references.citation: Am J Addict. 2009 May-Jun;18(3):206-18
references.pmid: 19340639
references.citation: Alcohol Clin Exp Res. 1996 Nov;20(8):1462-71
references.pmid: 8947326