Department of Psychology, 236 Audubon Hall, Louisiana State University, Baton Rouge, LA 70803, USA.
Addict Behav. 2012 Jun;37(6):722-8. doi: 10.1016/j.addbeh.2012.02.010. Epub 2012 Feb 17.
The present study examined the compatibility of the current DSM-IV and proposed DSM-5 diagnostic criteria for cocaine use disorders (CUD) among state prison inmates, and evaluated the diagnostic utility of the proposed criteria in accounting for DSM-IV "diagnostic orphans" (i.e., individuals who meet one or two of the diagnostic criteria for substance dependence yet fail to report indications of substance abuse).
Data were derived from routine clinical assessments of adult male inmates (N=6871) recently admitted to the Minnesota Department of Corrections state prison system from 2000 to 2003. An automated (i.e., computer-prompted) version of the Substance Use Disorder Diagnostic Schedule-IV (SUDDS-IV; Hoffmann & Harrison, 1995) was administered to all inmates as part of routine assessments. DSM-IV and DSM-5 criteria were coded using proposed guidelines.
The past 12-month prevalence of DSM-IV CUDs was 12.7% (Abuse, 3.8%, Dependence, 8.9%), while 11.0% met past 12-month DSM-5 criteria for a CUD (Moderate [MCUD], 1.7%; Severe [SCUD], 9.3%). When DSM-5 criteria were applied, 11.8% of the DSM-IV diagnostic orphans received a MCUD diagnosis. The vast majority of those with no diagnosis (99.6%) continued to have no diagnosis, and a similar proportion who met dependence criteria (98.4%) met SCUD criteria of the proposed DSM-5. Most of the variation in diagnostic classifications was accounted for by those with a current abuse diagnosis.
The proposed DSM-5 criteria perform similarly to DSM-IV criteria in terms of the observed past 12-month CUD prevalence and diagnostic classifications. The proposed criteria appear to account for diagnostic orphans that may warrant a diagnosis. DSM-IV abuse cases were most affected when DSM-5 criteria were applied. Additional criteria, beyond those included in the proposed DSM-5 changes, concerning use to relieve emotional stress and preoccupation with use were frequently endorsed by those with a proposed DSM-5 diagnosis.
本研究检验了 DSM-IV 现行诊断标准与 DSM-5 可卡因使用障碍（CUD）诊断标准在州监狱囚犯中的兼容性，并评估了拟议标准在解释 DSM-IV“诊断孤儿”（即符合物质依赖诊断标准之一或两项但未能报告物质滥用迹象的个体）方面的诊断效用。
数据来自 2000 年至 2003 年期间最近被明尼苏达州惩教署州监狱系统收监的成年男性囚犯的常规临床评估（N=6871）。所有囚犯都接受了自动（即计算机提示）版物质使用障碍诊断定式访谈-IV（SUDDS-IV；Hoffmann & Harrison，1995），作为常规评估的一部分。DSM-IV 和 DSM-5 标准使用拟议指南进行编码。
DSM-IV CUD 的过去 12 个月患病率为 12.7%（滥用 3.8%，依赖 8.9%），而 11.0%符合过去 12 个月 DSM-5 CUD 标准（中度[MCUD]1.7%，重度[SCUD]9.3%）。当应用 DSM-5 标准时，DSM-IV 诊断孤儿中有 11.8%被诊断为 MCUD。绝大多数无诊断者（99.6%）继续无诊断，且符合依赖标准者（98.4%）符合拟议 DSM-5 的 SCUD 标准。诊断分类的大部分差异由当前滥用诊断者引起。
就观察到的过去 12 个月 CUD 患病率和诊断分类而言，拟议的 DSM-5 标准与 DSM-IV 标准表现相似。拟议标准似乎解释了可能需要诊断的诊断孤儿。当应用 DSM-5 标准时，DSM-IV 滥用病例受影响最大。那些符合拟议 DSM-5 诊断的人经常赞同关于使用缓解情绪压力和专注于使用的附加标准，这些标准超出了拟议的 DSM-5 变更中包含的标准。
