Dimensionality of hallucinogen and inhalant/solvent abuse and dependence criteria: Implications for the diagnostic and statistical manual of mental disorders—Fifth edition

BackgroundPrior research has demonstrated the dimensionality of Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV) alcohol, nicotine, cannabis, cocaine and amphetamine abuse and dependence criteria. The purpose of this study was to examine the dimensionality of hallucinogen and inhalant/solvent abuse and dependence criteria. In addition, we assessed the impact of elimination of the legal problems abuse criterion on the information value of the aggregate abuse and dependence criteria, another proposed change for DSM-IV currently lacking empirical justification.MethodsFactor analyses and item response theory (IRT) analyses were used to explore the unidimisionality and psychometric properties of hallucinogen and inhalant/solvent abuse and dependence criteria using a large representative sample of the United States (U.S.) general population.ResultsHallucinogen and inhalant/solvent abuse and dependence criteria formed unidimensional latent traits. For both substances, IRT models without the legal problems abuse criterion demonstrated better fit than the corresponding model with the legal problem abuse criterion. Further, there were no differences in the information value of the IRT models with and without the legal problems abuse criterion, supporting the elimination of that criterion. No bias in the new diagnoses was observed by sex, age and race-ethnicity.ConclusionConsistent with findings for alcohol, nicotine, cannabis, cocaine and amphetamine abuse and dependence criteria, hallucinogen and inhalant/solvent criteria reflect underlying dimensions of severity. The legal problems criterion associated with each of these substance use disorders can be eliminated with no loss in informational value and an advantage of parsimony. Taken together, these findings support the changes to substance use disorder diagnoses recommended by the DSM-V Substance and Related Disorders Workgroup, that is, combining DSM-IV abuse and dependence criteria and eliminating the legal problems abuse criterion.

► Hallucinogen and inhalant/solvent abuse and dependence criteria mapped well onto a single dimensional construct of substance use disorder.
► Removal of the DSM-IV legal problems criterion did not affect the information value supporting its elimination for DSM-V diagnoses.
► Dimensionality of DSM-IV hallucinogen and inhalant/solvent criteria does not support two distinct disorders with abuse being prodromal to dependence.