Cottler L B
Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63110.
Addiction. 1993 May;88(5):689-96. doi: 10.1111/j.1360-0443.1993.tb02082.x.
At the present, the DSM-III-R is nearing the final stages of metamorphosis to DSM-IV. A series of field trials has been completed which has focused the attention on coverage of the different systems, the impact of social and legal problems on crossing the diagnostic threshold, the importance of subtyping by tolerance and withdrawal, the exclusionary diagnosis of abuse, the duration criterion, and other nosological comparisons. The focus of this Data Note is the comparison of rates between DSM-III, III-R, and both the old and new ICD-10 diagnostic systems, using data from the DSM-IV Substance Use Disorders Field Trials. Especially noteworthy is the inclusion of African Americans, females, and a population with a range of diagnoses and use patterns. Comparisons of DSM-III, III-R and ICD-10 substance use diagnoses among alcohol, nicotine, cannabis, cocaine substance users indicate considerable agreement for dependence but less similarities between systems for abuse and harmful use. These findings suggest that the dependence criteria may be more stable than those chosen to represent abuse and harmful use. More work needs to be done to evaluate the differences and similarities of the diagnostic systems.
目前，《精神疾病诊断与统计手册》第三版修订本（DSM - III - R）正接近向第四版（DSM - IV）转变的最后阶段。一系列现场试验已经完成，这些试验将注意力集中在不同系统的涵盖范围、社会和法律问题对跨越诊断阈值的影响、按耐受性和戒断进行亚型分类的重要性、滥用的排除性诊断、病程标准以及其他疾病分类比较上。本数据说明的重点是利用DSM - IV物质使用障碍现场试验的数据，对DSM - III、III - R以及旧版和新版国际疾病分类第十版（ICD - 10）诊断系统之间的比率进行比较。特别值得注意的是纳入了非裔美国人、女性以及具有一系列诊断和使用模式的人群。对酒精、尼古丁、大麻、可卡因使用者的DSM - III、III - R和ICD - 10物质使用诊断进行比较表明，在依赖方面有相当程度的一致性，但在滥用和有害使用的系统之间相似性较小。这些发现表明，依赖标准可能比用于表示滥用和有害使用的标准更稳定。需要做更多工作来评估诊断系统的差异和相似性。
