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Reviews and Overviews   |    
DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale
Deborah S. Hasin, Ph.D.; Charles P. O’Brien, M.D., Ph.D.; Marc Auriacombe, M.D.; Guilherme Borges, Sc.D.; Kathleen Bucholz, Ph.D.; Alan Budney, Ph.D.; Wilson M. Compton, M.D., M.P.E.; Thomas Crowley, M.D.; Walter Ling, M.D.; Nancy M. Petry, Ph.D.; Marc Schuckit, M.D.; Bridget F. Grant, Ph.D.
Am J Psychiatry 2013;170:834-851. doi:10.1176/appi.ajp.2013.12060782
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Dr. Auriacombe has received research grants or advisory board fees from D&A Pharma, Mundipharma, and Reckitt Benckiser Pharmaceuticals. Dr. Budney has received consulting fees from G.W. Pharmaceuticals. Dr. Compton has stock holdings in General Electric and Pfizer. Dr. Ling has received consulting fees or research, grant, or travel support from Alkermes, Braeburn Pharmaceuticals, Reckitt/Benckiser, Titan Pharmaceuticals, U.S. World Meds, and SGS North America. The other authors report no financial relationships with commercial interests.

Supported by the National Institute on Alcohol Abuse and Alcoholism (grants K05AA014223, U01AA018111), the National Institute on Drug Abuse (R01DA018652), and the New York State Psychiatric Institute (to Dr. Hasin).

The authors thank Katherine M. Keyes, Nick Giedris, and Dvora Shmulewitz for help in preparing the manuscript and Ray Anton, Robert Balster, Deborah Dawson, Danielle Dick, Joel Gelernter, Marilyn Huestis, John Hughes, Tom Kosten, Henry Kranzler, Tulshi Saha, Wim van den Brink, and Nora Volkow for their expert input.

The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or the U.S. government.

From the New York State Psychiatric Institute, New York; the Departments of Psychiatry and Epidemiology, Columbia University, New York; the Department of Psychiatry, University of Pennsylvania, Philadelphia; the Center for Studies of Addiction, Philadelphia; the Department of Addiction Psychiatry, Université Bordeaux Ségalen, Bordeaux, France; the National Institute of Psychiatry, Federal District, Mexico; the Department of Psychiatry, Washington University School of Medicine, St. Louis; the Center for Addiction Research, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock; the Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, Md.; the Department of Psychiatry and the Division of Substance Dependence, University of Colorado School of Medicine, Aurora; the Department of Psychiatry and Biobehavioral Sciences and the Integrated Substance Abuse Programs, University of California, Los Angeles; the Department of Psychiatry and the Behavioral Cardiovascular Prevention Calhoun Cardiology Center, University of Connecticut Health Center, Farmington; the Department of Psychiatry, San Diego VA Medical Center, San Diego; the Laboratory of Epidemiology and Biometry, National Institute on Alcohol Abuse and Alcoholism, Bethesda.

Address correspondence to Dr. Hasin (dsh2@columbia.edu).

Copyright © 2013 by the American Psychiatric Association

Received June 13, 2012; Revised January 22, 2013; Accepted February 11, 2013.

Abstract

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 available.

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