IMPACT OF THE DSM-IV TO DSM-5 CHANGES ON THE NATIONAL SURVEY ON DRUG USE AND HEALTH DISCLAIMER SAMHSA provides links to other Internet sites as a service to its users and is not responsible for the availability or content of these external sites. SAMHSA, its employees, and contractors do not endorse, warrant, or guarantee the products, services, or information described or offered at these other Internet sites. Any reference to a commercial product, process, or service is not an endorsement or recommendation by SAMHSA, its employees, or contractors. For documents available from this server, the U.S. Government does not warrant or assume any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, apparatus, product, or process disclosed. Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality Rockville, Maryland 20857 June 2016 This page intentionally left blank 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: RTI Project Director: Cristie Glasheen David Hunter Kathryn Batts Rhonda Karg SAMHSA Project Officer: Peter Tice SAMHSA Authors: Jonaki Bose Sarra Hedden Kathryn Piscopo For questions about this report, please e-mail [email protected]. 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. ii 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 iii 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 ..........................................................................................................................