WHO cross‐cultural applicability research on diagnosis and assessment of substance use disorders: an overview of methods and selected results

Abstract

The cross-cultural applicability of criteria for the diagnosis of substance use disorders and of instruments used for their assessment were studied in nine cultures. The qualitative and quantitative methods used in the study are described. Equivalents for English terms and concepts were found for all instrument items, diagnostic criteria, diagnoses and concepts, although often there was no single term equivalent to the English in the languages studied. Items assuming self-consciousness about feelings, and imputing causal relations, posed difficulties in several cultures. Single equivalent terms were lacking for some diagnostic criteria, and criteria were sometimes not readily differentiated from one another. Several criteria--narrowing of the drinking repertoire, time spent obtaining and using the drug, and tolerance for the drug--were less easy to use in cultures other than the United States. Thresholds for diagnosis used by clinicians often differed. In most cultures, clinicians were more likely to make a diagnosis of drug dependence than of alcohol dependence although behavioural signs were equivalent. The attitudes of societies to alcohol and drug use affects the use of criteria and the making of diagnoses.

Cultural context and impact of alcohol use in the Sundarban Delta, West Bengal, India

“…Consequently, clinical considerations are less relevant to community concerns. The comparative cultural question differs here from more typical cross-cultural critiques, which are concerned with applying diagnostic criteria inappropriately across cultures (Room et al, 1996). The focus on the clinical task of identifying individual cases for treatment differs from community concerns with deviance from community norms and changing community norms.…”

India: alcohol and public health

“…This was increasingly viewed as an unpopular imposition of English rule and drinking acquired the stature of a peculiarly English vice [22,23]. Alcohol use came to be regarded by the power elite as an atavistic trait of the primitive and the poor (tribals and socially backward drinking to transcend their miserable existence) or a licentious affectation of the upper classes [7,[24][25][26][27].…”

Differential Item Functioning Between Ethnic Groups in the Epidemiological Assessment of Depression

“…psychological constructs (Butcher et al, 2003;Janca, 2005;Room et al, 1996), including depression (Kleinman, 2004), concerns about the validity of this counterintuitive finding remain (Rogler, 1999). Measurement bias resulting from differential misclassification, with minorities being less likely to meet DSM criteria despite similar levels of underlying disorder, remains a potential methodological explanation for these findings (Rogler et al, 2001).…”