title: Prevalence of DSM-IV and DSM-5 alcohol, cocaine, opioid, and cannabis use disorders in a largely substance dependent sample.
abstract: BACKGROUND
  The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will soon replace the DSM-IV, which has existed for nearly two decades. The changes in diagnostic criteria have important implications for research and for the clinical care of individuals with Substance Use Disorders (SUDs).
  
  
  METHODS
  We used the Semi-Structured Assessment for Drug Dependence and Alcoholism to evaluate the lifetime presence of DSM-IV abuse and dependence diagnoses and DSM-5 mild, moderate, or severe SUDs for alcohol, cocaine, opioids, and cannabis in a sample of 7,543 individuals recruited to participate in genetic studies of substance dependence.
  
  
  RESULTS
  Switches between diagnostic systems consistently resulted in a modestly greater prevalence for DSM-5 SUDs, based largely on the assignment of DSM-5 diagnoses to DSM-IV "diagnostic orphans" (i.e., individuals meeting one or two criteria for dependence and none for abuse, and thus not receiving a DSM-IV SUD diagnosis). The vast majority of these diagnostic switches were attributable to the requirement that only two of 11 criteria be met for a DSM-5 SUD diagnosis. We found evidence to support the omission from DSM-5 of the legal criterion due to its limited diagnostic utility. The addition of craving as a criterion in DSM-5 did not substantially affect the likelihood of an SUD diagnosis.
  
  
  CONCLUSIONS
  The greatest advantage of DSM-5 for the diagnosis of SUDs appears to be its ability to capture diagnostic orphans. In this sample, changes reflected in DSM-5 had a minimal impact on the prevalence of SUD diagnoses.
authors.affiliation: Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.
authors.forename: Kyle
authors.initials: K
authors.lastname: Peer
authors.forename: Lior
authors.initials: L
authors.lastname: Rennert
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Lynch
authors.forename: Lindsay
authors.initials: L
authors.lastname: Farrer
authors.forename: Joel
authors.initials: J
authors.lastname: Gelernter
authors.forename: Henry R
authors.initials: HR
authors.lastname: Kranzler
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology; D016022:Case-Control Studies; D019970:Cocaine-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology