DSM-5 criteria for substance use disorders: Recommendations and rationale

Deborah S. Hasin, Charles P. O’Brien, Marc Auriacombe, Guilherme Borges, Kathleen Bucholz, Alan Budney, Wilson M. Compton, Thomas Crowley, Walter Ling, Nancy M. Petry, Marc Schuckit, Bridget F. Grant
AJP. 2013-08-01; 170(8): 834-851
DOI: 10.1176/appi.ajp.2013.12060782

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1. Am J Psychiatry. 2013 Aug;170(8):834-51. doi: 10.1176/appi.ajp.2013.12060782.

DSM-5 criteria for substance use disorders: recommendations and rationale.

Hasin DS(1), O’Brien CP, Auriacombe M, Borges G, Bucholz K, Budney A, Compton WM,
Crowley T, Ling W, Petry NM, Schuckit M, Grant BF.

Author information:
(1)New York State Psychiatric Institute, New York, USA.

Since DSM-IV was published in 1994, its approach to substance use disorders has
come under scrutiny. Strengths were identified (notably, reliability and validity
of dependence), but concerns have also arisen. The DSM-5 Substance-Related
Disorders Work Group considered these issues and recommended revisions for DSM-5.
General concerns included whether to retain the division into two main disorders
(dependence and abuse), whether substance use disorder criteria should be added
or removed, and whether an appropriate substance use disorder severity indicator
could be identified. Specific issues included possible addition of withdrawal
syndromes for several substances, alignment of nicotine criteria with those for
other substances, addition of biomarkers, and inclusion of nonsubstance,
behavioral addictions.This article presents the major issues and evidence
considered by the work group, which included literature reviews and extensive new
data analyses. The work group recommendations for DSM-5 revisions included
combining abuse and dependence criteria into a single substance use disorder
based on consistent findings from over 200,000 study participants, dropping legal
problems and adding craving as criteria, adding cannabis and caffeine withdrawal
syndromes, aligning tobacco use disorder criteria with other substance use
disorders, and moving gambling disorders to the chapter formerly reserved for
substance-related disorders. The proposed changes overcome many problems, while
further studies will be needed to address issues for which less data were

DOI: 10.1176/appi.ajp.2013.12060782
PMCID: PMC3767415
PMID: 23903334 [Indexed for MEDLINE]

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