How Should We Revise Diagnostic Criteria for Substance Use Disorders in the DSM—V?

摘要

This article reviews literature on the validity and performance characteristics of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM—IV; ) diagnostic criteria for substance use disorders (SUDs) and recommends changes in these criteria that should be considered for the next edition of the DSM (DSM—V). Substantial data indicate that DSM—IV substance abuse and substance dependence are not distinct categories and that SUD criteria are best modeled as reflecting a unidimensional continuum of substance-problem severity. The conceptually and empirically problematic substance abuse diagnosis should be abandoned in the DSM—V, with substance dependence defined by a single set of criteria. Data also indicate that various individual SUD criteria should be revised, dropped, or considered for inclusion in the DSM–V. The DSM–V should provide a framework that allows the integration of categorical and dimensional approaches to diagnosis. Important areas for further research are noted.