DSM-IV Dependence and DSM-5 SUD: Reliability and Validity in Patient Samples

描述(由申请人提供)：可靠和有效的精神病学诊断是临床实践和研究的核心，这些诊断是由临床医生和研究人员共同使用的语言《精神疾病诊断和统计手册》(DSM)定义的。在DSM-IV中，物质依赖是一个可靠和有效的诊断。然而，发现了DSM-IV滥用问题，以及DSM-IV对滥用和依赖的区分。在2013年5月刚刚发布的DSM-5中，滥用与依赖的区别被单一物质使用障碍(SUD)取代。新的DSM-5 SUD由11个标准定义：所有DSM-IV依赖标准、三个滥用标准和渴望，阈值为e2标准，严重程度由标准计数指示。虽然DSM-5的SUD改变解决了许多问题，但令人惊讶的是，这些问题被证明是有争议的，缺乏来自当前人群的数据，特别是接受治疗的人群，无法回答一些问题。在R01DA018652的初始资助期间，我们分析了有关滥用和依赖关系的现有数据(主要是流行病学数据)。这项研究是富有成效和成功的，为DSM-5 SUD变化提供了一些证据。然而，为了解决关于DSM-5 SUD的争议和问题，需要更多关于其可靠性和有效性的知识，特别是在目前正在接受治疗的患者中。我们建议更新，以研究新的DSM-5 SUD在临床样本中的优势和潜在弱点，并确定在DSM-5.1、5.2等中改进它的方法(预期间隔比DSM-IV和DSM-5之间的时间更短)。我们将通过收集纽约市四个社区治疗环境中600名使用药物的患者的新数据来解决这些问题，所有这些患者都有成功的先前研究合作。样本将在患者特征和使用的物质上有所不同。我们将重点关注酒精、大麻、可卡因、尼古丁和阿片类药物。训练有素的临床医生面谈将在基线、复测(1-21天后)、3个月和6个月时进行诊断面谈，涵盖DSM-IV和DSM-5 SUD标准。验证将利用先行变量(例如，家族历史)； 同时变量(例如，药物使用水平、功能、共病)；以及预测/预后(例如，症状和使用、功能方面的缓解和复发)。技术辅助数据收集将包括计算机辅助个人面谈(CAPI)；用于对验证变量进行私人评估的音频计算机辅助自我管理措施(A-CASI)；以及对于预期验证，通过交互式语音应答(IVR)每日简短地自我报告物质使用、渴望和功能。我们还将调查阈值；患者特征是否影响可靠性或有效性；以及重要的是，是否可以确定11 DSM-5 SUD标准的有效子集，以提供更短、更易于使用的列表。该团队在问题和方法方面经验丰富。我们的试点工作证明了项目的可行性。这项更新R01DA018652的修订提案响应了PA-11-230(用于预防、服务和病因学研究的药物表型)，其中由DSM-5定义的条件构成了一个很大的、重要的子集。

DESCRIPTION (provided by applicant): Reliable and valid psychiatric diagnoses are central to clinical practice and research, and these are defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), a common language for clinicians and researchers. In DSM-IV, substance dependence was a reliable and valid diagnosis. However, problems were identified with DSM-IV abuse, and with the DSM-IV distinction between abuse and dependence. In DSM-5, just published in May, 2013, the abuse-dependence distinction was replaced by a single Substance Use Disorder (SUD). The new DSM-5 SUD is defined by 11 criteria: all DSM-IV dependence criteria, three abuse criteria, and craving, with a threshold of e2 criteria, and severity indicated by a criteria count. While many problems were solved by the DSM-5 SUD changes, they proved surprisingly controversial, with data lacking from current populations, especially treated ones, to answer some of the questions. During the initial funding for R01DA018652, we analyzed existing data (largely epidemiologic) on the relationship of abuse and dependence. This study was productive and successful, contributing some of evidence regarding the DSM-5 SUD changes. However, to address controversies and questions about DSM-5 SUD, more knowledge is needed about its reliability and validity, particularly among patients currently in treatment. We propose a renewal to investigate the strengths and potential weaknesses of the new DSM-5 SUD in clinical samples, and to identify ways to improve it in DSM-5.1, 5.2 etc. (anticipated at briefer intervals than the time between DSM- IV and DSM-5). We will address these issues by collecting new data from 600 substance-using patients in four New York City community treatment settings, all with successful prior research collaborations. The sample will be diverse in patient characteristics and in substances used. We will focus on alcohol, cannabis, cocaine, nicotine and opioids. Trained clinician interviewers will give diagnostic interviews covering DSM-IV and DSM-5 SUD criteria at baseline, retest (1-21 days later), 3 months and 6 months. Validation will utilize antecedent variables (e.g., family history); concurrent variables (e.g., substance use level, functioning, comorbidity); and prediction/prognosis (e.g., remission and relapse in symptoms and use, functioning). Technology-assisted data collection will include Computer-Assisted Personal Interviews (CAPI); Audio Computer-Assisted Self- administered measures for private assessment of validation variables (A-CASI); and, for prospective validation, brief daily self-reports of substance use, craving, and functioning via interactive voice response (IVR). We will also investigate thresholds; whether patient characteristics affect reliability or validity; and importantly, whethe a valid subset of the 11 DSM-5 SUD criteria can be identified to provide a shorter, easier-to-use list. The team is highly experienced with the issues and methods. Our pilot work demonstrates project feasibility. This revised proposal for a renewal of R01DA018652 responds to PA-11-230 (drug phenotypes for prevention, services and etiologic research), of which conditions defined by DSM-5 form a large, important subset.