Diagnostic Issues in Substance Use Disorders

Inviting the help of colleagues worldwide, the concise
Diagnostic Issues in Substance Use Disorders is part of the new
series Advancing the Research Agenda for DSM-V. Its 19 chapters by an
international group of experts are designed to stimulate questions that will
help guide research related to the development of the next editions of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and
the International Classification of Diseases (ICD-11), with the goal
of ensuring that the major substance use diagnoses represent the same
condition in both references. They cover 10 major issues in three main sections:


* Overarching issues relevant for the development of international
diagnostic systems-statistical modeling techniques and whether DSM-V
should use categorical and/or dimensional diagnostic approaches; methods
review, emphasizing new hybrid techniques for developing and testing
diagnostic concepts; the need for separate clinical and research-oriented
diagnostic criteria, incorporating both categorical and dimensional
attributes; neurobiological changes characterizing substance dependence; the
importance of cultural attributes in developing definitions of substance use
disorders; and the history of the development of diagnostic systems and how
to optimize the "crosswalk" between DSM and ICD.
* Research questions
more specific to the substance use disorders section of
DSM-comorbidity between substance use disorders and other psychiatric
conditions, the relatively unique clinical course of substance-induced
mental disorders and appropriate treatment approaches; the precision of the
criteria and threshold for a diagnosis and how to improve them; the subtypes
of substance use disorder, including how they have been derived and the
extent to which they relate to neurobiological processes; the seemingly high
prevalence of alcohol dependence in young people; suggested research
questions to evaluate the application of diagnostic criteria to adolescents;
and the specific psychoactive substances cannabis and nicotine.
*
Whether substance use disorders should be included in a broader
section termed "addictive disorders"-impulse-control disorders
(especially pathological gambling and the advantages and disadvantages of
adding it to the current substance use disorders section), identifying
research opportunities regarding their assessment and neurocognitive and
physiological bases, discussing the specifics of the research agenda and how
it might be implemented, and presenting questions generated by the research
agenda developmental process.

This informative compendium distills
the findings of a wealth of recent research and concludes with
recommendations for exploiting research opportunities that promise to inform
decisions regarding DSM-V and other classification systems. As such, it will
prove invaluable for clinicians and researchers everywhere.