Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Alcohol Clin Exp Res. 2017 Sep;41(9):1584-1592. doi: 10.1111/acer.13441. Epub 2017 Jul 24.
Proposed International Classification of Diseases, 11th edition (ICD-11), criteria for substance use disorder (SUD) radically simplify the algorithm used to diagnose substance dependence. Major differences in case identification across DSM and ICD impact determinations of treatment need and conceptualizations of substance dependence. This study compared the draft algorithm for ICD-11 SUD against DSM-IV, DSM-5, and ICD-10, for alcohol and cannabis.
Adolescents (n = 339, ages 14 to 18) admitted to intensive outpatient addictions treatment completed, as part of a research study, a Structured Clinical Interview for DSM SUDs adapted for use with adolescents and which has been used to assess DSM and ICD SUD diagnoses. Analyses examined prevalence across classification systems, diagnostic concordance, and sources of diagnostic disagreement.
Prevalence of any past-year proposed ICD-11 alcohol or cannabis use disorder was significantly lower compared to DSM-IV and DSM-5 (ps < 0.01). However, prevalence of proposed ICD-11 alcohol and cannabis dependence diagnoses was significantly higher compared to DSM-IV, DSM-5, and ICD-10 (ps < 0.01). ICD-11 and DSM-5 SUD diagnoses showed only moderate concordance. For both alcohol and cannabis, youth typically met criteria for an ICD-11 dependence diagnosis by reporting tolerance and much time spent using or recovering from the substance, rather than symptoms indicating impaired control over use.
The proposed ICD-11 dependence algorithm appears to "overdiagnose" dependence on alcohol and cannabis relative to DSM-IV and ICD-10 dependence, and DSM-5 moderate/severe use disorder, generating potential "false-positive" cases of dependence. Among youth who met criteria for proposed ICD-11 dependence, few reported impaired control over substance use, highlighting ongoing issues in the conceptualization and diagnosis of SUD.
国际疾病分类第 11 版（ICD-11）提出的物质使用障碍（SUD）标准极大地简化了用于诊断物质依赖的算法。DSM 和 ICD 之间在病例识别方面的主要差异会影响治疗需求的确定和物质依赖的概念化。本研究比较了 ICD-11 SUD 的草案算法与 DSM-IV、DSM-5 和 ICD-10 对酒精和大麻的应用。
作为一项研究的一部分，339 名 14 至 18 岁的青少年在门诊强化戒毒治疗中完成了 DSM 物质使用障碍的结构性临床访谈改编版，该访谈用于评估 DSM 和 ICD 的物质使用障碍诊断。分析考察了在不同分类系统中的患病率、诊断一致性以及诊断分歧的来源。
与 DSM-IV 和 DSM-5 相比，任何过去一年的拟议 ICD-11 酒精或大麻使用障碍的患病率明显较低（p<0.01）。然而，与 DSM-IV、DSM-5 和 ICD-10 相比，拟议的 ICD-11 酒精和大麻依赖诊断的患病率明显较高（p<0.01）。ICD-11 和 DSM-5 的 SUD 诊断仅有中度一致性。对于酒精和大麻，青少年通常通过报告耐受和大量时间用于或从物质中恢复，而不是表明对使用的控制受损的症状，符合 ICD-11 依赖诊断标准。
与 DSM-IV 和 ICD-10 依赖以及 DSM-5 中度/重度使用障碍相比，拟议的 ICD-11 依赖算法似乎“过度诊断”了酒精和大麻的依赖，这会产生潜在的“假阳性”依赖病例。在符合拟议的 ICD-11 依赖标准的青少年中，很少有人报告对物质使用的控制受损，突出了 SUD 的概念化和诊断方面的持续问题。
