Impact of the DSM-IV to DSM-5 Changes on the National ...

IMPACT OF THE DSM-IV TO DSM-5 CHANGES ON THE NATIONAL SURVEY

ON DRUG USE AND HEALTH

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Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality Rockville, Maryland 20857 June 2016

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IMPACT OF THE DSM-IV TO DSM-5

CHANGES ON THE NATIONAL

SURVEY ON DRUG USE AND

HEALTH

Contract No. HHSS283201000003C

RTI Project No. 0212800.001.108.006.026

RTI Authors: Cristie Glasheen Kathryn Batts Rhonda Karg

SAMHSA Authors: Jonaki Bose Sarra Hedden Kathryn Piscopo

RTI Project Director: David Hunter

SAMHSA Project Officer: Peter Tice

For questions about this report, please e-mail Peter.Tice@samhsa.. Prepared for Substance Abuse and Mental Health Services Administration, Rockville, Maryland Prepared by RTI International, Research Triangle Park, North Carolina

June 2016

Recommended Citation: Center for Behavioral Health Statistics and Quality. (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, Rockville, MD.

Acknowledgments

This report would not be possible without the guidance and input of staff from the Center for Behavioral Health Statistics and Quality. In particular, at the Substance Abuse and Mental Health Services Administration: Janet Kuramoto, Dicy Painter, and Peggy Barker. At RTI International (a trade name of Research Triangle Institute), Mark Edlund, Justin Landwehr, and Jennifer Schoden.

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Table of Contents

Chapter

Page

Executive Summary .........................................................................................................................1

1. Introduction..........................................................................................................................3

2. Substance Use Disorders......................................................................................................5 2.1 Overview................................................................................................................. 5 2.2 Categorization Changes .......................................................................................... 5 2.3 Types of Substances................................................................................................ 9 2.4 Criteria for Substance Use Disorders...................................................................... 9 2.4.1 Substance Abuse and Substance Dependence .......................................... 10 2.4.2 Withdrawal Criteria .................................................................................. 11 2.4.3 Severity Criteria ........................................................................................ 15 2.5 Specific SUDs....................................................................................................... 15 2.5.1 Alcohol Use Disorder ............................................................................... 15 2.5.2 Caffeine Use Disorder............................................................................... 22 2.5.3 Cannabis Use Disorder ............................................................................. 22 2.5.4 Phencyclidine Use Disorder and Other Hallucinogen Use Disorder ........ 24 2.5.5 Inhalant Use Disorder ............................................................................... 29 2.5.6 Opioid Use Disorder ................................................................................. 33 2.5.7 Sedative, Hypnotic, or Anxiolytic Use Disorder ...................................... 44 2.5.8 Stimulant Use Disorder............................................................................. 50 2.5.9 Tobacco Use Disorder............................................................................... 61 2.5.10 Other Considerations ................................................................................ 61 2.6 Substance Use Disorders in NSDUH.................................................................... 62

3. Mental Illness.................................................................................................................... 65 3.1 Mental Illness in NSDUH and MHSS: Overview ................................................ 65 3.2 Overarching Structural Changes in the DSM ....................................................... 67 3.2.1 Elimination of the Multi-Axial System..................................................... 67 3.2.2 Removal of the GAF score ....................................................................... 68 3.2.3 Disorder Reclassification .......................................................................... 71 3.3 Changes to NSDUH/MHSS Included Diagnoses ................................................. 77 3.3.1 Major Depressive Episode/Disorder (NSDUH and MHSS)..................... 77 3.3.2 Dysthymic Disorder (MHSS) ................................................................... 80 3.3.3 Manic Episode and Bipolar I Disorder (MHSS)....................................... 82 3.3.4 Panic Disorder and Agoraphobia (MHSS) ............................................... 91 3.3.5 Specific Phobia (MHSS)........................................................................... 95 3.3.6 Social Phobia (MHSS).............................................................................. 97 3.3.7 Obsessive-Compulsive Disorder (MHSS) ................................................ 98 3.3.8 Posttraumatic Stress Disorder (MHSS) .................................................. 100 3.3.9 Generalized Anxiety Disorder (MHSS).................................................. 104 3.3.10 Anorexia Nervosa (MHSS)..................................................................... 105 3.3.11 Bulimia Nervosa (MHSS)....................................................................... 107 3.3.12 Intermittent Explosive Disorder (MHSS) ............................................... 108

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3.3.13 Adjustment Disorder (MHSS) ................................................................ 110 3.3.14 Psychotic Disorders (MHSS) .................................................................. 112 3.4 Additional Disorders for Consideration.............................................................. 117 3.4.1 Neurodevelopmental Disorders .............................................................. 118 3.4.2 Schizophrenia Spectrum and Other Psychotic Disorders ....................... 122 3.4.3 Bipolar and Related Disorders ................................................................ 127 3.4.4 Depressive Disorders .............................................................................. 129 3.4.5 Anxiety Disorders ................................................................................... 131 3.4.6 Obsessive-Compulsive and Related Disorders ....................................... 133 3.4.7 Trauma- and Stressor-Related Disorders ................................................ 138 3.4.8 Somatic Symptom and Related Disorders .............................................. 141 3.4.9 Feeding and Eating Disorders ................................................................. 145 3.4.10 Sleep-Wake Disorders ............................................................................ 149 3.4.11 Disruptive, Impulse-Control, and Conduct Disorders ............................ 153 3.4.12 Substance-Related and Addictive Disorders........................................... 157 3.4.13 Personality Disorders .............................................................................. 159 3.4.14 Disorders Due to a Medical Condition, Substance Use, or

Medications............................................................................................. 159 3.4.15 Other Specified Disorders....................................................................... 160 3.5 Other Disorders in the DSM ............................................................................... 160 3.6 Any Mental Illness, Serious Mental Illness, and Specific Disorders in NSDUH/MHSS................................................................................................... 166 3.6.1 Impact of DSM Revisions on MHSS Estimates of SMI, AMI and

Specific Disorders................................................................................... 166 3.6.2 Impact on Estimates of Any Mental Illness/Serious Mental Illness ....... 166 3.6.3 Impact on NSDUH Major Depressive Episode Estimates...................... 171 References ....................................................................................................................................173

Appendixes A Additional Substance Use Disorder Tables: Weighted N among People Aged 12

or Older ........................................................................................................................... A-1 B Additional Substance Use Disorder Tables: Prevalence among Past Year

Substance Using Peoplersons Aged 12 or Older .............................................................B-1

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List of Tables

Table

Page

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 Percentages, Annual Averages Based on 2002-2012 NSDUHs ..........................................................................................................17

2.4 Prevalence of DSM-5 Alcohol Use Disorder Craving Criterion from Available Studies ................................................................................................................................18

2.5 Alcohol Use Disorder among Persons Aged 12 or Older under DSM-IV and DSM-5 Criteria, by Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ..........................................................................20

2.6 Respondents Who Endorsed Only One Alcohol Use Disorder Criterion among Persons Aged 12 or Older, by Criterion and Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs........................21

2.7 Marijuana Legal Criterion Endorsement among Persons Aged 12 or Older, by Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ..........................................................................................................23

2.8 Prevalence of DSM-5 Cannabis Use Disorder Craving Criterion from Available Studies ................................................................................................................................24

2.9 Phencyclidine or Other Hallucinogen Use Legal Criterion Endorsement among Persons Aged 12 or Older, by Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ........................................26

2.10 Phencyclidine Use Disorder or Other Hallucinogen Use Disorder among Persons Aged 12 or Older under DSM-IV and DSM-5 Criteria, by Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ............................................................................................................................27

2.11 Respondents Who Endorsed Only One Phencyclidine Use Disorder or Other Hallucinogen Use Disorder Criterion among Persons Aged 12 or Older, by Criterion and Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ..........................................................................28

2.12 Inhalant Legal Criterion Endorsement among Persons Aged 12 or Older, by Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ..........................................................................................................30

2.13 Inhalant Use Disorder among Persons Aged 12 or Older under DSM-IV and DSM-5 Criteria, by Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ..........................................................................31

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List of Tables (continued)

Table

Page

2.14 Respondents Who Endorsed Only One Inhalant Use Disorder Criterion among Persons Aged 12 or Older, by Criterion and Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs........................32

2.15 Heroin Legal Criterion Endorsement among Persons Aged 12 or Older, by Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ..........................................................................................................34

2.16 Pain Reliever Legal Criterion Endorsement among Persons Aged 12 or Older, by Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ..........................................................................................................35

2.17 Heroin/Pain Reliever Legal Criterion Endorsement among Persons Aged 12 or Older, by Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ..........................................................................................36

2.18 Prevalence of DSM-5 Opioid Use Disorder Craving Criterion from Available Studies ................................................................................................................................37

2.19 Heroin Use Disorder among Persons Aged 12 or Older under DSM-IV and DSM5 Criteria, by Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ..........................................................................38

2.20 Respondents Who Endorsed Only One Heroin Use Disorder Criterion among Persons Aged 12 or Older, by Criterion and Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs........................39

2.21 Pain Reliever Use Disorder among Persons Aged 12 or Older under DSM-IV and DSM-5 Criteria, by Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ..........................................................................40

2.22 Respondents Who Endorsed Only One Pain Reliever Use Disorder Criterion among Persons Aged 12 or Older, by Criterion and Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs........................41

2.23 Heroin/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 .............................................................42

2.24 Respondents Who Endorsed Only One Heroin/Pain Reliever Use Disorder Criterion among Persons Aged 12 or Older, by Criterion and Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ............................................................................................................................43

2.25 Sedative Legal Criterion Endorsement among Persons Aged 12 or Older, by Demographic Characteristic: Weighted Percentages, Annual Averages Based on 2002-2012 NSDUHs ..........................................................................................................45

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