ABSTRACT
Aims: Compared to DSM-IV nicotine dependence, proposed DSM-5 Nicotine Use Disorder (NUD) would lower the threshold from 3 to 2 symptoms, and increase the number of criteria used for diagnosis from 7 to 11. The impact of the proposed changes on nicotine disorder prevalence, and the concurrent validity of diagnostic criteria were examined.
Design: Cross-sectional survey to compare DSM-IV and proposed DSM-5 algorithms.
Setting and Participants: Adolescent (N=179) and young adult (N=292) past year cigarette users recruited from addictions treatment.
Measurements: Semi-structured clinical interview to evaluate DSM-IV nicotine dependence, and 10 of the 11 proposed DSM-5 NUD criteria; 30-day Time Line Follow-Back; and Fagerstrom Test for Nicotine Dependence (FTND).
Findings: Prevalence of proposed DSM-5 NUD (2-symptom threshold) was much higher (adolescents: 69%, young adults: 86%) than DSM-IV nicotine dependence (33% and 60%, respectively), although prevalence of DSM-5 severe NUD (4-symptom threshold) was similar to DSM-IV nicotine dependence. Concurrent validity analyses in both samples indicated consistent support for DSM-5 severe NUD diagnosis (4-symptoms) but not for the moderate NUD (2-symptoms) diagnosis, which had modest relations with only FTND score. IRT analyses indicated strong support for the new Craving item, but not for the proposed Interpersonal Problems and Hazardous Use items.
Conclusions: The proposed DSM-5 Nicotine Use Disorder criteria have substantial limitations when applied to adolescents and young adults, and appear to have low concurrent validity.