Validity of the DSM-5 craving criterion for alcohol, tobacco, cannabis, cocaine, heroin, and non-prescription use of prescription painkillers (opioids).

BACKGROUND: Although the DSM-5 was adopted in 2013, the validity of the new substance use disorder (SUD) diagnosis and craving criterion has not been investigated systematically across substances. METHODS: Adults (N = 588) who engaged in binge drinking or illicit drug use and endorsed at least one DSM-5 SUD criterion were included. DSM-5 SUD criteria were assessed for alcohol, tobacco, cannabis, cocaine, heroin, and opioids. Craving was considered positive if "wanted to use so badly that could not think of anything else" (severe craving) or "felt a very strong desire or urge to use" (moderate craving) was endorsed. Baseline information on substance-related variables and psychopathology was collected, and electronic daily assessment queried substance use for the following 90 days. For each substance, logistic regression estimated the association between craving and validators, i.e. variables expected to be related to craving/SUD, and whether association with the validators differed for DSM-5 SUD diagnosed with craving as a criterion v. without. RESULTS: Across substances, craving was associated with most baseline validators (p values<0.05); neither moderate nor severe craving consistently showed greater associations. Baseline craving predicted subsequent use [odds ratios (OR): 4.2 (alcohol) - 234.3 (heroin); p's ⩽ 0.0001], with stronger associations for moderate than severe craving (p's < 0.05). Baseline DSM-5 SUD showed stronger associations with subsequent use when diagnosed with craving than without (p's < 0.05). CONCLUSION: The DSM-5 craving criterion as operationalized in this study is valid. Including craving improves the validity of DSM-5 SUD diagnoses, and clinical relevance, since craving may cause impaired control over use and development and maintenance of SUD.

Validity of proposed DSM-5 diagnostic criteria for nicotine use disorder: results from 734 Israeli lifetime smokers.

BACKGROUND: The fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) proposes aligning nicotine use disorder (NUD) criteria with those for other substances, by including the current DSM fourth edition (DSM-IV) nicotine dependence (ND) criteria, three abuse criteria (neglect roles, hazardous use, interpersonal problems) and craving. Although NUD criteria indicate one latent trait, evidence is lacking on: (1) validity of each criterion ; (2) validity of the criteria as a set ; (3) comparative validity between DSM-5 NUD and DSM-IV ND criterion sets ; and (4) NUD prevalence. METHOD: Nicotine criteria (DSM-IV ND, abuse and craving) and external validators (e.g., smoking soon after awakening, number of cigarettes per day) were assessed with a structured interview in 734 lifetime smokers from an Israeli household sample. Regression analysis evaluated the association between validators and each criterion. Receiver operating characteristic analysis assessed the association of the validators with the DSM-5 NUD set (number of criteria endorsed) and tested whether DSM-5 or DSM-IV provided the most discriminating criterion set. Changes in prevalence were examined. RESULTS: Each DSM-5 NUD criterion was significantly associated with the validators, with strength of associations similar across the criteria. As a set, DSM-5 criteria were significantly associated with the validators, were significantly more discriminating than DSM-IV ND criteria, and led to increased prevalence of binary NUD (two or more criteria) over ND. CONCLUSIONS: All findings address previous concerns about the DSM-IV nicotine diagnosis and its criteria and support the proposed changes for DSM-5 NUD, which should result in improved diagnosis of nicotine disorders.

A low-cost, sustainable intervention for drinking reduction in the HIV primary care setting.

Excess drinking poses multiple substantial health risks to HIV-infected individuals. However, no published intervention studies have focused on drinking reduction as the main outcome in HIV primary care patients. An intervention in this setting must place minimal demands on pressured staff and resources. This pilot study tested such an intervention, which consisted of brief Motivational Interviewing (MI) and HealthCall, an automated daily telephone self-monitoring system based on Interactive Voice Response (IVR), designed to extend and enhance the effects of brief MI. Thirty-one patients entered the study, received a 30-minute MI and were instructed in daily use of the IVR system. They received graphical feedback on their daily drinking from the HealthCall database after 30 days. A statistically significant decrease in drinking was found over time, both as reported in daily IVR calls (beta = - 0.01, se 0.01, p=.03) and in follow-up interviews (beta = - 0.04, se 0.12, p=.02) at 60 days. The proportion of daily calls made supported the feasibility of the intervention. The results indicate that HealthCall is acceptable to a disadvantaged HIV patient population, and preliminary data support the efficacy of this intervention in reducing harmful drinking among HIV primary care patients.

Differences in drinking patterns among Ashkenazic and Sephardic Israeli adults.

OBJECTIVE: Since its foundation in 1948, Israel has received large waves of immigrants, mainly from Europe (Ashkenazic Jews, or Ashkenazim) and from North Africa and other Middle Eastern countries (Sephardic Jews. or Sephardim). In Israeli society, Ashkenazic Jews are an advantaged ethnic group, whereas Sephardic Jews are relatively disadvantaged. Little is known about the differences in drinking patterns between these two groups. The relationship between ethnicity and alcohol consumption is investigated in a 1995 data set from a sample of 4,984 subjects (60% women). METHOD: The data were collected as part of a national Israeli survey. Standardized questions covered drinking and becoming drunk in the last 12 months and drinking in the last 30 days. Unadjusted odds ratios (ORs) indicated the association of group status with the drinking variables. ORs adjusted for potential confounders were created with logistic regression. RESULTS: Unadjusted ORs indicated a negative association between all alcohol measures and Sephardic group status. ORs adjusted for such factors as socioeconomic status and religiosity produced similar results. CONCLUSIONS: This study indicates that Sephardim were less likely to drink or become drunk than were Ashkenazim. Further work is required to determine if these differences are stable or changing over time and whether such differences can be attributed to cultural or genetic factors. Similarities to U.S. patterns are discussed.

Anger and depressive states among treatment-seeking drug abusers: testing the psychopharmacological specificity hypothesis.

The aim of this study was to examine the self-medication hypothesis (SMH) of substance abuse. The SMH suggests that drug abuse is driven by an attempt to alleviate specific psychological distress. One prediction from the SMH hypothesis is that drugs of abuse, because of their different pharmacological properties, attract specific patient subgroups. Specifically, this study tested the hypothesis' that opiate abusers experience difficulty managing aggression and that cocaine abusers suffer from distress associated mostly with depression. The State-Trait Anger Expression Inventory (STAXI) and the Beck Depression Inventory II were used to examine levels of anger and depression among three groups of substance abusers (opiates, cocaine, cannabis), defined by their primary drug of abuse. Anger and depression scores were elevated, but contrary to Khantzian's hypothesis, there were few differences between groups, and if anything, opiate addicts were more depressed and the cocaine abusers were angrier on several subscales. Data are discussed in terms of diagnosis and clinical treatment implications.