University of Bordeaux, Addiction Team, Sleep Addiction and Neuropsychiatry Laboratory (SANPSY), Bordeaux, France; USR CNRS 3413, Bordeaux, France; Pôle Addictologie, CH Ch. Perrens and CHU de Bordeaux, Bordeaux, France.
New York State Psychiatric Institute, New York, NY, United States; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States.
Addict Behav. 2021 May;116:106797. doi: 10.1016/j.addbeh.2020.106797. Epub 2020 Dec 25.
To examine differences in the psychometric characteristics of diagnostic criteria for Substance Use Disorders (SUD) between substance users in harm reduction settings (HR) and substance users seeking treatment (Tx).
Differential Item and Test Functioning (DIF & DTF) analysis were performed to examine differences in the difficulty of endorsement and in discrimination of the 11 diagnostic criteria and to test if the criteria set as a whole (the "test") functioned differently by care settings (Tx vs. HR) for alcohol, cocaine, cannabis, opiates and tobacco. To test uniform and nonuniform DIF, multiple indicator multiple cause (MIMIC) structural equation models were used.
Regardless of the substance, the DSM-5 criteria "craving", "large amount", "time spent", "tolerance" and "activities given up" had similar functioning by care settings. Little evidence for DIF was found for other criteria. The criteria set as a whole did not function differently by care settings for alcohol, cocaine and tobacco. At the same trait severity, compared to HR, the Tx subgroup had a greater number of endorsed criteria for cannabis and a smaller number of endorsed criteria for opioids.
The unidimensionality of the 11 DSM-5 criteria and applicability of all criteria and diagnosis was confirmed in this large sample of problematic substance users. While the majority of the criteria related to loss of control of substance use, functioned well in both care settings, the criteria related to consequences of substance use had several differential functioning.
考察在减少伤害环境（HR）中使用物质的人和寻求治疗的物质使用者（Tx）之间，物质使用障碍（SUD）诊断标准的心理计量学特征差异。
采用不同项目和测试功能（DIF 和 DTF）分析，考察 11 个诊断标准的认可难度和区分度的差异，并检验标准集（“测试”）是否因护理环境（Tx 与 HR）的不同而对酒精、可卡因、大麻、阿片类药物和烟草产生不同的作用。为了检验均匀和非均匀的 DIF，采用多指标多原因（MIMIC）结构方程模型。
无论物质如何，DSM-5 标准中的“渴求”、“大量”、“花费时间”、“耐受”和“放弃活动”在护理环境上具有相似的功能。其他标准的 DIF 证据很少。对于酒精、可卡因和烟草，标准集作为一个整体在护理环境上没有不同的功能。在相同的特质严重程度下，与 HR 相比，Tx 亚组对大麻的认可标准更多，对阿片类药物的认可标准更少。
在这个有问题的物质使用者的大样本中，11 项 DSM-5 标准的一维性和所有标准和诊断的适用性得到了证实。虽然大多数与物质使用失控有关的标准在两种护理环境中都能很好地发挥作用，但与物质使用后果有关的标准在功能上存在差异。
