Does DSM-5 nomenclature for inhalant use disorder improve upon DSM-IV?

Abstract

Among drug classes, substance use disorder (SUD) consequent to using inhalants (SUD-I) has perhaps the smallest evidence base. This study compared SUD-IV vs. SUD-5 nomenclatures, testing whether four traditional categories of inhalants (aerosols, gases, nitrites, solvents) are manifestations of a single pathology, obtaining item parameters of SUD-I criteria, and presenting evidence that SUD can result from using nitrites. An urban, Midwestern, community sample of 162 inhalant users was recruited. Participants were 2/3 male, nearly 85% Caucasian, and had a mean age of 20.3 years (SD=2.4 years), spanning the ages of greatest incidence of SUD and slightly older than the primary ages of inhalants use initiation. Analyses consisted of bivariate associations, principle components analysis, and item response theory analysis. Validity was demonstrated for SUD-I consequent to each inhalant type as well as for aggregating all inhalant types into a single drug class. Results supported DSM-5 nomenclature over DSM-IV in multiple ways except that occurrence of diagnostic orphans was not statistically smaller using DSM-5.

Commonalities and Differences Across Substance Use Disorders: Phenomenological and Epidemiological Aspects

“…Therefore, in DSM-5, the distinction between dependence and abuse was removed, replaced with one combined “substance use disorder” consisting of eleven criteria to diagnose all SUD (Table 1), of which 2 or more criteria within a 12-month period were required (American Psychiatric Association, 2013). A craving criterion (strong desire for the substance) was added, since it fit well with the dependence and abuse criteria across substances (alcohol (Borges et al, 2011; Casey et al, 2012; Castaldelli-Maia et al, 2015; Cherpitel et al, 2010; Hasin et al, 2012; Keyes et al, 2011a; Mewton et al, 2011a; Mewton et al, 2011b; Preuss et al, 2014); stimulants (Gilder et al, 2014; Hasin et al, 2012); tobacco (Chung et al, 2012; Shmulewitz et al, 2011; Strong et al, 2009; Strong et al, 2012); cannabis, heroin (Hasin et al, 2012); inhalants (Ridenour et al, 2014)), had potential clinical utility, and to enhance consistency with ICD-10 (Hasin et al, 2013b). A withdrawal criterion was added for cannabis given considerable evidence for its existence (Hasin et al, 2013b), and tobacco disorder criteria were aligned with the other substances (American Psychiatric Association, 2013).…”

“…This supported replacing the two DSM-IV disorders (dependence, abuse) with a single combined disorder in DSM-5. More recent IRT studies continue to consistently indicate unidimensionality for alcohol (Castaldelli-Maia et al, 2015; Preuss et al, 2014, Hagman and Cohn, 2013, Kuerbis et al, 2013b, Ehlke et al, 2012, Rose et al, 2012, Edwards et al, 2013, Wu et al, 2013, Derringer et al, 2013), cannabis (Wu et al, 2013, Gizer et al, 2013, Derringer et al, 2013), cocaine and stimulants (Wu et al, 2013, Derringer et al, 2013, Gilder et al, 2014), opioids (Wu et al, 2013), and inhalants (Ridenour et al, 2014). The unidimensionality evidence also supports dimensional SUD severity scales across all substances; such scales are important in both research and clinical work as they provide information beyond a binary diagnosis (Grant et al, 2015, Hasin et al, 2015).…”

“…A few studies on hallucinogens (Gillespie et al, 2007, Cottler et al, 2009) and inhalants (Ridenour et al, 2007, Perron et al, 2011, Ridenour et al, 2014) suggested that withdrawal symptoms were endorsed, showed acceptable reliability and validity, and fit the underlying disorder latent construct. Yet, a distinct set of symptoms remains to be identified for hallucinogens (Cottler et al, 2009) and inhalants (Ridenour et al, 2014); additional research is needed to determine if identification of such a syndrome is possible (Hasin et al, 2013b). …”

Investigação de critérios diagnósticos utilizados no transtorno do uso de nicotina do DSM-5 em indivíduos da Área Metropolitana de São Paulo

“…The following socio-demographic correlates were considered: gender, age (categorized as [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] and 55 years or more); education (0-4, 5-8, 9-11, 12 years or more, respectively defined as low, low-average, high-average, and high); marital status (married/cohabiting, previously married [separated/divorced/widowed], never married); employment (working/student, homemaker, retired, unemployed/other);…”

“…The new structure of the DSM-5 [11] fuses abuse and dependence criteria from DSM-IV and ICD-10 for tobacco similar to those used in all substance disorders [12], paralleling the conceptual framework of alcohol [13], cannabis [14], stimulants [15], opioids [16], sedatives/tranquilizers [17], hallucinogens [18], and inhalants [19]. However, in the ICD-11, which should be released in 2018, the concepts and diagnostic categories of dependence and harmful use have been maintained [20].…”