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诊断是临床实践和研究的核心，这些诊断由精神疾病诊断和统计手册（DSM）定义，这是临床医生和研究人员的共同语言。在DSM-IV中，物质依赖是一个可靠和有效的诊断。然而，问题被确定与DSM-IV滥用，与DSM-IV之间的滥用和依赖的区别。在2013年5月出版的DSM-5中，滥用依赖的区别被单一的物质使用障碍（SUD）所取代。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表示。虽然DSM-5 SUD的变化解决了许多问题，但令人惊讶的是，它们引起了争议，缺乏来自当前人群的数据，特别是接受治疗的人群，以回答一些问题。在R 01 DA 018652的初始资助期间，我们分析了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的和成功的，贡献了一些关于DSM-5 SUD变化的证据。然而，为了解决有关DSM-5 SUD的争议和问题，需要对其可靠性和有效性有更多的了解，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DSM-5 SUD在临床样本中的优点和潜在缺点，并确定在DSM-5.1、5.2等中改进它的方法（预计间隔比DSM- IV和DSM-5之间的时间更短）。我们将通过收集来自纽约市四个社区治疗机构的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所用物质方面多样化。我们将侧重于酒精、大麻、可卡因、尼古丁和阿片类药物。经过培训的临床医生访谈员将在基线、复检（1-21天后）、3个月和6个月时提供涵盖DSM-IV和DSM-5 SUD标准的诊断访谈。验证将利用先行变量（例如，家族史）; 并发变量（例如，物质使用水平、功能、合并症）;和预测/预后（例如，症状和使用、功能的缓解和复发）。技术辅助的数据收集将包括计算机辅助个人访谈（CAPI）;用于验证变量私人评估的音频计算机辅助自我管理措施（A-CASI）;以及，对于前瞻性验证，通过交互式语音应答（IVR）进行药物使用、渴望和功能的简短每日自我报告。我们还将调查阈值;患者特征是否影响可靠性或有效性;重要的是，是否可以确定DSM-5 SUD标准的11个有效子集，以提供更短的，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。R 01 DA 018652更新的修订提案响应了PA-11-230（用于预防、服务和病因学研究的药物表型），其中DSM-5定义的疾病形成了一个重要的大子集。

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.