title: Greater prevalence of proposed DSM-5 nicotine use disorder compared to DSM-IV nicotine dependence in treated adolescents and young adults.
abstract: OBJECTIVE
  Compared to DSM-IV nicotine dependence, proposed DSM-5 nicotine use disorder (NUD) would lower the threshold from three to two symptoms, and increase the number of criteria used for diagnosis from seven to 11. The impact of the proposed changes on nicotine disorder prevalence and the concurrent validity of diagnostic criteria were examined.
  
  
  METHODS
  Cross-sectional survey to compare DSM-IV and proposed DSM-5 algorithms.
  
  
  METHODS
  Adolescent (n = 179) and young adult (n = 292) past-year cigarette users recruited from addictions treatment.
  
  
  METHODS
  Semi-structured clinical interview to evaluate DSM-IV nicotine dependence, and 10 of the 11 proposed DSM-5 NUD criteria; 30-day time-line follow-back; and the Fagerström Test for Nicotine Dependence (FTND).
  
  
  RESULTS
  Prevalence of proposed DSM-5 NUD (two-symptom threshold) was much higher (adolescents: 68.7%, young adults: 86.0%) than DSM-IV nicotine dependence (33.0% and 59.6%, respectively), although prevalence of DSM-5 severe NUD (four-symptom threshold) was similar to DSM-IV nicotine dependence. Concurrent validity analyses in both samples indicated consistent support for DSM-5 severe NUD diagnosis (four symptoms) but not for the moderate NUD (two symptoms) diagnosis, which had modest relations with only FTND score. IRT analyses indicated strong support for the new craving item, but not for the proposed interpersonal problems and hazardous use items.
  
  
  CONCLUSIONS
  The proposed DSM-5 nicotine use disorder criteria have substantial limitations when applied to adolescents and young adults, and appear to have low concurrent validity.
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA, USA. chungta@upmc.edu
authors.forename: Tammy
authors.initials: T
authors.lastname: Chung
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Martin
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Maisto
authors.forename: Jack R
authors.initials: JR
authors.lastname: Cornelius
authors.forename: Duncan B
authors.initials: DB
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D016739:Behavior, Addictive / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology; D014029:Tobacco Use Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation; D055815:Young Adult
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