Proctor Steven L, Kopak Albert M, Hoffmann Norman G
Department of Psychology.
Department of Criminology and Criminal Justice, Western Carolina University.
Psychol Addict Behav. 2014 Jun;28(2):563-7. doi: 10.1037/a0033369. Epub 2013 Aug 5.
This article presents a secondary analysis from a study investigating the compatibility of the current DSM-IV and previously proposed DSM-5 cocaine use disorder (CUD) criteria (S. L. Proctor, A. M. Kopak, & N. G. Hoffmann, 2012, Compatibility of current DSM-IV and proposed DSM-5 diagnostic criteria for cocaine use disorders. Addictive Behaviors, 37, 722-728). The current analyses examined the compatibility of the current DSM-IV and two sets of proposed DSM-5 diagnostic criteria for CUDs among adult male inmates (N = 6,871) recently admitted to the Minnesota Department of Corrections state prison system from 2000-2003. Initially proposed DSM-5 criteria (DSM-5.0) featured only two diagnostic designations (i.e., moderate and severe). A subsequent revision (DSM-5.1) included the addition of a mild designation and required a greater number of positive findings for the severe designation. A computer-prompted structured diagnostic interview was administered to all inmates as part of routine clinical assessments. The past 12-month prevalence of DSM-IV CUDs was 12.70% (Abuse, 3.78%, Dependence, 8.92%), while 10.98% met past 12-month DSM-5.1 criteria for a CUD (Mild [MiCUD], 1.72%; Moderate [MCUD], 1.12%; and Severe [SCUD], 8.14%). The vast majority of those with no diagnosis (99.6%) continued to have no diagnosis, and most of those with a dependence diagnosis (91.2%) met SCUD criteria of the proposed DSM-5.1. Most of the variation in DSM-5.1 diagnostic classifications was accounted for by those with a current abuse diagnosis. DSM-5.0 MCUD cases were most affected when DSM-5.1 criteria were applied. The proposed diagnostic changes might translate to reduced access to treatment for those individuals evincing symptoms consistent with DSM-IV cocaine abuse.
本文呈现了一项研究的二次分析，该研究调查了当前的《精神疾病诊断与统计手册第四版》（DSM-IV）与先前提出的《精神疾病诊断与统计手册第五版》（DSM-5）可卡因使用障碍（CUD）标准的兼容性（S.L. 普罗克特、A.M. 科帕克和N.G. 霍夫曼，2012年，《当前DSM-IV与提议的DSM-5可卡因使用障碍诊断标准的兼容性》。《成瘾行为》，第37卷，第722 - 728页）。当前的分析检验了在2000年至2003年期间最近被明尼苏达州惩教部州监狱系统收押的成年男性囚犯（N = 6871）中，当前DSM-IV与两套提议的DSM-5可卡因使用障碍诊断标准的兼容性。最初提议的DSM-5标准（DSM-5.0）仅包含两种诊断类别（即中度和重度）。随后的修订版（DSM-5.1）增加了轻度类别，并对重度类别要求有更多的阳性发现。作为常规临床评估的一部分，对所有囚犯进行了计算机辅助的结构化诊断访谈。DSM-IV可卡因使用障碍过去12个月的患病率为12.70%（滥用，3.78%；依赖，8.92%），而10.98%的人符合过去12个月DSM-5.1的可卡因使用障碍标准（轻度[轻度可卡因使用障碍（MiCUD）]，1.72%；中度[中度可卡因使用障碍（MCUD）]，1.12%；重度[重度可卡因使用障碍（SCUD）]，8.14%）。绝大多数未被诊断的人（99.6%）仍然未被诊断，并且大多数被诊断为依赖的人（91.2%）符合提议的DSM-5.1的重度可卡因使用障碍标准。DSM-5.1诊断分类中的大多数差异是由当前被诊断为滥用的人造成的。当应用DSM-5.1标准时，DSM-5.0的中度可卡因使用障碍病例受到的影响最大。提议的诊断变化可能会导致那些表现出与DSM-IV可卡因滥用一致症状的人获得治疗的机会减少。
