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，这些都是由精神疾病诊断和统计手册（DSM）定义的，这是临床医生和研究人员的共同语言。在DSM-IV中，物质依赖是一种可靠有效的诊断。然而，问题被确定为DSM-IV滥用，以及DSM-IV对滥用和依赖的区分。在2013年5月刚刚出版的DSM-5中，滥用与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，3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，但它们证明了令人惊讶的争议，缺乏来自当前人群的数据，特别是经过治疗的人群，来回答一些问题。在R01DA018652的初始资助期间，我们分析了滥用与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的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（预计在比DSM- IV和DSM-5之间的时间间隔更短的时间间隔）。我们将通过收集来自纽约市四个社区治疗机构的600名药物使用患者的新数据来解决这些问题，所有这些患者之前都有成功的研究合作。样本在患者特征和使用的物质上是多种多样的。我们将重点关注酒精、大麻、可卡因、尼古丁和阿片类药物。经过培训的临床医生将在基线、复测（1-21天后）、3个月和6个月时对DSM-IV和DSM-5的SUD标准进行诊断性访谈。验证将利用前因变量（如家族史）；

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.