Impact Of The DSM-IV To DSM-5 Changes On The National .
IMPACT OF THE DSM-IV TO DSM-5CHANGES ON THE NATIONAL SURVEYON DRUG USE AND HEALTHDISCLAIMERSAMHSA provides links to other Internet sites as a service to its users and is not responsible for the availability orcontent of these external sites. SAMHSA, its employees, and contractors do not endorse, warrant, or guarantee theproducts, services, or information described or offered at these other Internet sites. Any reference to a commercialproduct, process, or service is not an endorsement or recommendation by SAMHSA, its employees, or contractors.For documents available from this server, the U.S. Government does not warrant or assume any legal liability orresponsibility for the accuracy, completeness, or usefulness of any information, apparatus, product, or processdisclosed.Substance Abuse and Mental Health Services AdministrationCenter for Behavioral Health Statistics and QualityRockville, Maryland 20857June 2016
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IMPACT OF THE DSM-IV TO DSM-5CHANGES ON THE NATIONALSURVEY ON DRUG USE ANDHEALTHContract No. HHSS283201000003CRTI Project No. 0212800.001.108.006.026RTI Project Director:RTI Authors:David HunterCristie GlasheenKathryn BattsRhonda KargSAMHSA Project Officer:Peter TiceSAMHSA Authors:Jonaki BoseSarra HeddenKathryn PiscopoFor questions about this report, please e-mail Peter.Tice@samhsa.hhs.gov.Prepared for Substance Abuse and Mental Health Services Administration,Rockville, MarylandPrepared by RTI International, Research Triangle Park, North CarolinaJune 2016Recommended Citation: Center for Behavioral Health Statistics and Quality.(2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey onDrug Use and Health. Substance Abuse and Mental Health ServicesAdministration, Rockville, MD.
AcknowledgmentsThis report would not be possible without the guidance and input of staff from the Center forBehavioral Health Statistics and Quality. In particular, at the Substance Abuse and MentalHealth Services Administration: Janet Kuramoto, Dicy Painter, and Peggy Barker. At RTIInternational (a trade name of Research Triangle Institute), Mark Edlund, Justin Landwehr, andJennifer Schoden.ii
Table of ContentsChapterPageExecutive Summary .11.Introduction .32.Substance Use Disorders.52.1Overview . 52.2Categorization Changes . 52.3Types of Substances. 92.4Criteria for Substance Use Disorders . 92.4.1 Substance Abuse and Substance Dependence . 102.4.2 Withdrawal Criteria . 112.4.3 Severity Criteria . 152.5Specific SUDs . 152.5.1 Alcohol Use Disorder . 152.5.2 Caffeine Use Disorder. 222.5.3 Cannabis Use Disorder . 222.5.4 Phencyclidine Use Disorder and Other Hallucinogen Use Disorder . 242.5.5 Inhalant Use Disorder . 292.5.6 Opioid Use Disorder . 332.5.7 Sedative, Hypnotic, or Anxiolytic Use Disorder . 442.5.8 Stimulant Use Disorder . 502.5.9 Tobacco Use Disorder. 612.5.10 Other Considerations . 612.6Substance Use Disorders in NSDUH . 623.Mental Illness . 65Mental Illness in NSDUH and MHSS: Overview . 653.13.2Overarching Structural Changes in the DSM . 673.2.1 Elimination of the Multi-Axial System. 673.2.2 Removal of the GAF score . 683.2.3 Disorder Reclassification . 713.3Changes to NSDUH/MHSS Included Diagnoses . 773.3.1 Major Depressive Episode/Disorder (NSDUH and MHSS) . 773.3.2 Dysthymic Disorder (MHSS) . 803.3.3 Manic Episode and Bipolar I Disorder (MHSS) . 823.3.4 Panic Disorder and Agoraphobia (MHSS) . 913.3.5 Specific Phobia (MHSS) . 953.3.6 Social Phobia (MHSS) . 973.3.7 Obsessive-Compulsive Disorder (MHSS) . 983.3.8 Posttraumatic Stress Disorder (MHSS) . 1003.3.9 Generalized Anxiety Disorder (MHSS) . 1043.3.10 Anorexia Nervosa (MHSS) . 1053.3.11 Bulimia Nervosa (MHSS) . 1073.3.12 Intermittent Explosive Disorder (MHSS) . 108iii
3.43.53.63.3.13 Adjustment Disorder (MHSS) . 1103.3.14 Psychotic Disorders (MHSS) . 112Additional Disorders for Consideration . 1173.4.1 Neurodevelopmental Disorders . 1183.4.2 Schizophrenia Spectrum and Other Psychotic Disorders . 1223.4.3 Bipolar and Related Disorders . 1273.4.4 Depressive Disorders . 1293.4.5 Anxiety Disorders . 1313.4.6 Obsessive-Compulsive and Related Disorders . 1333.4.7 Trauma- and Stressor-Related Disorders . 1383.4.8 Somatic Symptom and Related Disorders . 1413.4.9 Feeding and Eating Disorders . 1453.4.10 Sleep-Wake Disorders . 1493.4.11 Disruptive, Impulse-Control, and Conduct Disorders . 1533.4.12 Substance-Related and Addictive Disorders. 1573.4.13 Personality Disorders . 1593.4.14 Disorders Due to a Medical Condition, Substance Use, orMedications . 1593.4.15 Other Specified Disorders . 160Other Disorders in the DSM . 160Any Mental Illness, Serious Mental Illness, and Specific Disorders inNSDUH/MHSS . 1663.6.1 Impact of DSM Revisions on MHSS Estimates of SMI, AMI andSpecific Disorders . 1663.6.2 Impact on Estimates of Any Mental Illness/Serious Mental Illness . 1663.6.3 Impact on NSDUH Major Depressive Episode Estimates . 171References .173AppendixesAAdditional Substance Use Disorder Tables: Weighted N among People Aged 12or Older . A-1BAdditional Substance Use Disorder Tables: Prevalence among Past YearSubstance Using Peoplersons Aged 12 or Older .B-1iv
List of TablesTablePage2.1Comparison of DSM-IV, DSM-5, and NSDUH Substance Use DisorderAssessment .62.2DSM-IV to DSM-5 Withdrawal Symptom Comparison .122.3Alcohol Legal Criterion Endorsement among Persons Aged 12 or Older, byDemographic Characteristic: Weighted Percentages, Annual Averages Based on2002-2012 NSDUHs .172.4Prevalence of DSM-5 Alcohol Use Disorder Craving Criterion from AvailableStudies .182.5Alcohol Use Disorder among Persons Aged 12 or Older under DSM-IV andDSM-5 Criteria, by Demographic Characteristic: Weighted Percentages, AnnualAverages Based on 2002-2012 NSDUHs .202.6Respondents Who Endorsed Only One Alcohol Use Disorder Criterion amongPersons Aged 12 or Older, by Criterion and Demographic Characteristic:Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs.212.7Marijuana Legal Criterion Endorsement among Persons Aged 12 or Older, byDemographic Characteristic: Weighted Percentages, Annual Averages Based on2002-2012 NSDUHs .232.8Prevalence of DSM-5 Cannabis Use Disorder Craving Criterion from AvailableStudies .242.9Phencyclidine or Other Hallucinogen Use Legal Criterion Endorsement amongPersons Aged 12 or Older, by Demographic Characteristic: WeightedPercentages, Annual Averages Based on 2002-2012 NSDUHs .262.10Phencyclidine Use Disorder or Other Hallucinogen Use Disorder among PersonsAged 12 or Older under DSM-IV and DSM-5 Criteria, by DemographicCharacteristic: Weighted Percentages, Annual Averages Based on 2002-2012NSDUHs .272.11Respondents Who Endorsed Only One Phencyclidine Use Disorder or OtherHallucinogen Use Disorder Criterion among Persons Aged 12 or Older, byCriterion and Demographic Characteristic: Weighted Percentages, AnnualAverages Based on 2002-2012 NSDUHs .282.12Inhalant Legal Criterion Endorsement among Persons Aged 12 or Older, byDemographic Characteristic: Weighted Percentages, Annual Averages Based on2002-2012 NSDUHs .302.13Inhalant Use Disorder among Persons Aged 12 or Older under DSM-IV andDSM-5 Criteria, by Demographic Characteristic: Weighted Percentages, AnnualAverages Based on 2002-2012 NSDUHs .31v
List of Tables (continued)TablePage2.14Respondents Who Endorsed Only One Inhalant Use Disorder Criterion amongPersons Aged 12 or Older, by Criterion and Demographic Characteristic:Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs.322.15Heroin Legal Criterion Endorsement among Persons Aged 12 or Older, byDemographic Characteristic: Weighted Percentages, Annual Averages Based on2002-2012 NSDUHs .342.16Pain Reliever Legal Criterion Endorsement among Persons Aged 12 or Older, byDemographic Characteristic: Weighted Percentages, Annual Averages Based on2002-2012 NSDUHs .352.17Heroin/Pain Reliever Legal Criterion Endorsement among Persons Aged 12 orOlder, by Demographic Characteristic: Weighted Percentages, Annual AveragesBased on 2002-2012 NSDUHs .362.18Prevalence of DSM-5 Opioid Use Disorder Craving Criterion from AvailableStudies .372.19Heroin Use Disorder among Persons Aged 12 or Older under DSM-IV and DSM5 Criteria, by Demographic Characteristic: Weighted Percentages, AnnualAverages Based on 2002-2012 NSDUHs .382.20Respondents Who Endorsed Only One Heroin Use Disorder Criterion amongPersons Aged 12 or Older, by Criterion and Demographic Characteristic:Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs.392.21Pain Reliever Use Disorder among Persons Aged 12 or Older under DSM-IV andDSM-5 Criteria, by Demographic Characteristic: Weighted Percentages, AnnualAverages Based on 2002-2012 NSDUHs .402.22Respondents Who Endorsed Only One Pain Reliever Use Disorder Criterionamong Persons Aged 12 or Older, by Criterion and Demographic Characteristic:Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs.412.23Heroin/Pain Reliever Use Disorder among Persons Aged 12 or Older under DSMIV and DSM-5 Criteria, by Demographic Characteristic: Weighted Percentages,Annual Averages Based on 2002-2012 NSDUHs .422.24Respondents Who Endorsed Only One Heroin/Pain Reliever Use DisorderCriterion among Persons Aged 12 or Older, by Criterion and DemographicCharacteristic: Weighted Percentages, Annual Averages Based on 2002-2012NSDUHs .432.25Sedative Legal Criterion Endorsement among Persons Aged 12 or Older, byDemographic Characteristic: Weighted Percentages, Annual Averages Based on2002-2012 NSDUHs .45vi
List of Tables (continued)TablePage2.26Tranquilizer Legal Criterion Endorsement among Persons Aged 12 or Older, byDemographic Characteristic: Weighted Percentages, Annual Averages Based on2002-2012 NSDUHs .462.27Sedative/Tranquilizer Legal Criterion Endorsement among Persons Aged 12 orOlder, by Demographic Characteristic: Weighted Percentages, Annual AveragesBased on 2002-2012 NSDUHs .472.28Sedative Use Disorder among Persons Aged 12 or Older under DSM-IV andDSM-5 Criteria, by Demographic Characteristic: Weighted Percentages, AnnualAverages Based on 2002-2012 NSDUHs .482.29Respondents Who Endorsed Only One Sedative Use Disorder Criterion amongPersons Aged 12 or Older, by Criterion and Demographic Characteristic:Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs.492.30Stimulant Legal Criterion Endorsement among Persons Aged 12 or Older, byDemographic Characteristic: Weighted Percentages, Annual Averages Based on2002-2012 NSDUHs .512.31Cocaine Legal Criterion Endorsement among Persons Aged 12 or Older, byDemographic Characteristic: Weighted Percentages, Annual Averages Based on2002-2012 NSDUHs .522.32Stimulant/Cocaine Legal Criterion Endorsement among Persons Aged 12 orOlder, by Demographic Characteristic: Weighted Percentages, Annual AveragesBased on 2002-2012 NSDUHs .532.33Prevalence of DSM-5 Cocaine Use Disorder Craving Criterion from AvailableStudies .542.34Stimulant Use Disorder among Persons Aged 12 or Older under DSM-IV andDSM-5 Criteria, by Demographic Characteristic: Weighted Percentages, AnnualAverages Based on 2002-2012 NSDUHs .552.35Respondents Who Endorsed Only One Stimulant Use Disorder Criterion amongPersons Aged 12 or Older, by Criterion and Demographic Characteristic:Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs.562.36Cocaine Use Disorder among Persons Aged 12 or Older under DSM-IV andDSM-5 Criteria, by Demographic Characteristic: Weighted Percentages, AnnualAverages Based on 2002-2012 NSDUHs .572.37Respondents Who Endorsed Only One Cocaine Use Disorder Criterion amongPersons Aged 12 or Older, by Criterion and Demographic Characteristic:Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs.58vii
List of Tables (continued)TablePage2.38Stimulant/Cocaine Use Disorder among Persons Aged 12 or Older under DSM-IVand DSM-5 Criteria, by Demographic Characteristic: Weighted Percentages,Annual Averages Based on 2002-2012 NSDUHs .592.39Respondents Who Endorsed Only One Stimulant/Cocaine Use Disorder Criterionamong Persons Aged 12 or Older, by Criterion and Demographic Characteristic:Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs.603.1Interrater Reliability Exercise Performance: 2008-2012 MHSS .693.2Disorder Classes Presented by the DSM-IV and DSM-5, as Ordered in DSM-IV .713.3Disorder Classification in the DSM-IV and DSM-5.
2.1 Comparison of DSM-IV, DSM-5, and NSDUH Substance Use Disorder Assessment 6 2.2 DSM-IV to DSM-5 Withdrawal Symptom Comparison 12 2.3 Alcohol Legal Criterion Endorsement among Persons Aged 12 or Older, by Demographic Characteristic: Weighted
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Using DSM-IV, you make a diagnosis of alcohol abuse. Using DSM-5, you make a diagnosis of alcohol use disorder, mild. ICD-9-CM DSM-IV dx –305.00 ICD-9-CM DSM-5 dx –305.00 ICD-10-CM DSM-5 dx –F10.10 DSM-IV Substance abuse crosswalks to mild SUD in DSM-5. Substance dependence crosswalks to moderate
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