DSM-5 substance use disorder: how conceptual missteps weakened the foundations of the addictive disorders field

Clarifying Relations Between Core Features of Psychopathy and Substance (Mis)use: A Replication and Extension in Two Large Independent Samples

Two studies examined the consistency of associations between specific components of psychopathy and two indices of drug use: (a) abstinence and (b) severity (i.e., counts) of lifetime substance use disorder (SUD) symptoms. Participants were 418 male county jail inmates in Illinois (Study One) and 354 male state prison inmates in New Mexico (Study Two). Across samples, lifestyle and antisocial trait ratings were associated with a reduced likelihood of abstinence from most substances. Lifestyle traits were also uniquely associated with severity of substance dependence ratings. Consistent with prior research, interpersonal traits were uniquely related to cocaine indices in both samples. Furthermore, analyses revealed negative associations between the affective features of psychopathy and alcohol dependence in one sample (Study Two), and illicit substance use across samples. These findings demonstrate the robustness of the associations between the interpersonal and affective features of psychopathy and specific aspects of substance (mis)use.

Parents Rate Problematic Video Streaming in Adolescents: Conceptualization and External Assessment of a New Clinical Phenomenon Based on the ICD-11 Criteria of Gaming Disorder

In recent years, video streaming (VS) increased substantially. Adolescents are at significant risk of presenting problematic VS patterns associated with a spectrum of mental-health difficulties. Because VS platforms rely on similar mechanisms as digital games, the ICD-11 criteria for Gaming Disorder (GD) have been successfully implemented to measure Streaming Disorder (StrD) in adolescents. For proper diagnoses, external rating scales are urgently required in addition to self-reports. The Streaming Disorder Scale for Parents (STREDIS-P) was created and validated in a representative sample of n = 891 adolescent-parent dyads. Mental health problems were assessed with standardized instruments. Confirmatory factor analysis was conducted to examine the underlying factor structure. Cutoff scores were determined using ROC analysis. Accordance between parental and adolescents' self-ratings was calculated. Consistent with the results of previous validation studies for screening instruments assessing similar phenomena based on ICD-11-GD criteria, two factors, cognitive-behavioral symptoms and negative consequences, were confirmed. STREDIS-P demonstrated good to excellent internal consistency, criterion validity, and discriminatory power. Accordance with adolescents' self-ratings was moderate. STREDIS-P is the first screening tool for assessing StrD in adolescents by parental ratings. It is highly relevant for conceptualizing a new phenomenon in clinical routine and academic research.

Diagnosing Prescription Opioid Use Disorder in Patients Using Prescribed Opioids for Chronic Pain

OBJECTIVE

The diagnostic criteria for opioid use disorder, originally developed for heroin, did not anticipate the surge in prescription opioid use and the resulting complexities in diagnosing prescription opioid use disorder (POUD), including differentiation of pain relief (therapeutic intent) from more common drug use motives, such as to get high or to cope with negative affect. The authors examined the validity of the Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 opioid version, an instrument designed to make this differentiation.

METHODS

Patients (N=606) from pain clinics and inpatient substance treatment who ever received a ≥30-day opioid prescription for chronic pain were evaluated for DSM-5 POUD (i.e., withdrawal and tolerance were not considered positive if patients used opioids only as prescribed, per DSM-5 guidelines) and pain-adjusted POUD (behavioral/subjective criteria were not considered positive if pain relief [therapeutic intent] was the sole motive). Bivariate correlated-outcome regression models indicated associations of 10 validators with DSM-5 and pain-adjusted POUD measures, using mean ratios for dimensional measures and odds ratios for binary measures.

RESULTS

The prevalences of DSM-5 and pain-adjusted POUD, respectively, were 44.4% and 30.4% at the ≥2-criteria threshold and 29.5% and 25.3% at the ≥4-criteria threshold. Pain adjustment had little effect on prevalence among substance treatment patients but resulted in substantially lower prevalence among pain treatment patients. All validators had significantly stronger associations with pain-adjusted than with DSM-5 dimensional POUD measures (ratios of mean ratios, 1.22-2.31). For most validators, pain-adjusted binary POUD had larger odds ratios than DSM-5 measures.

CONCLUSIONS

Adapting POUD measures for pain relief (therapeutic intent) improved validity. Studies should investigate the clinical utility of differentiating between therapeutic and nontherapeutic intent in evaluating POUD diagnostic criteria.

International Classification of Diseases-11-Based External Assessment of Social Media Use Disorder in Adolescents: Development and Validation of the Social Media Use Disorder Scale for Parents

Social media use disorder (SMUD) is associated with substantial impairments in daily functioning, and adolescents are particularly at risk. The 11th revision of the International Classification of Diseases (ICD-11) criteria of gaming disorder (GD) could be shown to be suitable to describe SMUD in adolescents. Since adolescents' insight might be limited due to young age or symptom denial, it is essential to include their parents in the diagnostic process. The development and validation of a parental scale are, therefore, of great interest to clinicians and scientists. The Social Media Use Disorder Scale for Parents (SOMEDIS-P) was developed by clinical experts and validated in 944 parent-child dyads. Adolescents were 10-17 years old and frequently used social media (SM). Besides SM use times, standardized questionnaires were applied to assess SM use patterns according to ICD-11 and Diagnostic and Statistical Manual of Mental Disorders-5 criteria of (Internet) GD, psychological stress, and depressive symptoms in an online survey. Item structure was investigated by confirmatory factorial analysis. Receiver operating characteristic curve analyses to determine cutoff values and accordance with adolescent self-ratings were computed. A presumed two-factorial structure of SOMEDIS-P could be confirmed describing cognitive-behavioral symptoms and negative consequences. The instrument showed good to excellent internal consistency and criterion validity with moderate to strong correlations, excellent discriminatory characteristics, and moderate accordance with the adolescents' self-ratings. As the first successfully validated tool for the assessment of ICD-11-based SMUD in adolescents by parental judgment, SOMEDIS-P can make an important contribution to reliable SMUD screening in clinical practice and research.

Applying ICD-11 criteria of Gaming Disorder to identify problematic video streaming in adolescents: Conceptualization of a new clinical phenomenon

Background and aims

Internet video streaming (VS) has become a popular leisure activity among the majority of adolescents, especially under the COVID-19 pandemic. Research on binge watching patterns in adults suggests an addictive potential of VS. To date, no unified conceptualization on problematic VS and no standardized assessment tools for adolescents exist even though they might be especially vulnerable.

Methods

STREDIS-A is based on the ICD-11 criteria of gaming disorder. It was validated in a representative sample of 959 dyads of 10- to 17-year old adolescents with frequent VS and a respective parent using standardized questionnaires on Internet addiction, depressive and anxiety symptoms, insomnia, loneliness, and academic performance in an online survey. Item structure was investigated by factorial analyses. Cutoffs were estimated and latent profile analysis was performed.

Results

The two-factorial structure of STREDIS-A describes cognitive-behavioral symptoms and negative consequences of VS. Internal consistency and criterion validity were good to excellent. It could excellently discriminate between affected and non-affected adolescents.

Discussion and conclusions

The present study makes a significant contribution to the conceptualization of a new phenomenon. It provides the very first tool to assess streaming disorder in adolescents for clinical and research settings. Clinical validation is highly warranted.

Klerman's "credo" reconsidered: neo-Kraepelinianism, Spitzer's views, and what we can learn from the past

In 1978, G. Klerman published an essay in which he named the then-nascent "neo-Kraepelinian" movement and formulated a "credo" of nine propositions expressing the movement's essential claims and aspirations. Klerman's essay appeared on the eve of the triumph of neo-Kraepelinian ideas in the DSM-III. However, this diagnostic system has subsequently come under attack, opening the way for competing proposals for the future of psychiatric nosology. To better understand what is at stake, in this paper I provide a close reading and consideration of Klerman's credo in light of the past forty years of research and reflection. The credo is placed in the context of two equally seminal publications in the same year, one by S. Guze, the leading neo-Kraepelinian theorist, and the other by R. Spitzer and J. Endicott, defining mental disorder. The divergences between Spitzer and standard neo-Kraepelinianism are highlighted and argued to be much more important than is generally realized. The analysis of Klerman's credo is also argued to have implications for how to satisfactorily resolve the current nosological ferment in psychiatry. In addition to issues such as creating descriptive syndromal diagnostic criteria, overthrowing psychoanalytic dominance of psychiatry, and making psychiatry more scientific, neo-Kraepelinians were deeply concerned with the conceptual issue of the nature of mental disorder and the defense of psychiatry's medical legitimacy in response to antipsychiatric criticisms. These issues cannot be ignored, and I argue that proposals currently on offer to replace the neo-Kraepelinian system, especially popular proposals to replace it with dimensional measures, fail to adequately address them.

Does crude measurement contribute to observed unidimensionality of psychological constructs? A demonstration with DSM-5 alcohol use disorder

Mental disorders are complex, multifaceted phenomena that are associated with profound heterogeneity and comorbidity. Despite the heterogeneity of mental disorders, most are generally considered unitary dimensions. We argue that certain measurement practices, especially using too few indicators per construct, preclude the detection of meaningful multidimensionality. We demonstrate the implications of crude measurement for detecting construct multidimensionality with alcohol use disorder (AUD). To do so, we used a large sample of college heavy drinkers (N = 909) for whom AUD symptomology was thoroughly assessed (87 items) and a blend of confirmatory factor analysis, exploratory factor analysis, and hierarchical clustering. A unidimensional AUD model with one item per symptom criterion fit the data well, whereas a unidimensional model with all items fit the data poorly. Starting with an 11-item AUD model, model fit decreased and the variability in factor loadings increased as additional items were added to the model. Additionally, multidimensional models outperformed unidimensional ones in terms of variance explained in theoretically relevant external criteria. All told, we converged on a hierarchically organized model of AUD with three broad, transcriterial dimensions that reflected tolerance, withdrawal, and loss of control. In addition to introducing a hierarchical model of AUD, we propose that thorough assessment of psychological constructs paired with serious consideration of alternative, multidimensional structures can move past the deadlock of their unidimensional representations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

ICD-11-Based Assessment of Social Media Use Disorder in Adolescents: Development and Validation of the Social Media Use Disorder Scale for Adolescents

Background: A problematic social media use (PSMU) in adolescents is a rising phenomenon often associated with higher perception of psychological stress and comorbid psychiatric disorders like depression. Since the ICD-11 introduced the very first internet-use related disorders, criteria for gaming (and online gambling) disorder can now be transferred to assess social media use disorder (SMUD). Therefore, the development and validation of a self-rating screening instrument for SMUD is of value to researchers and clinicians. Method: The previously validated ICD-11-based Gaming Disorder Scale for Adolescents (GADIS-A) was adapted to measure SMUD (Social Media Use Disorder Scale for Adolescents, SOMEDIS-A). A representative sample of 931 adolescents aged 10 to 17 years and a respective parent participated in an online study. Item structure was evaluated by factorial analyses. Validated DSM-5-based instruments to assess PSMU by self- and parental ratings (SMDS, SMDS-P), adolescent depressive symptoms (PHQ-9), and stress perception (PSS-10) as well as single items on time spent with social media (SM, frequency and duration) were applied to assess criterion validity. Discrimination between pathological and non-pathological users was examined based on ROC analyses retrieved cut-off values and the results of a latent profile analysis. Results: The new scale is best described by two factors reflecting cognitive-behavioral symptoms and associated negative consequences. The internal consistency was good to excellent. The SOMEDIS-A-sum score was positively correlated with PSMU, depression, and stress scores as well as the time spent with SM in a moderately to highly significant manner. Thus, good to excellent criterion validity is suggested. Conclusions: SOMEDIS-A is the first successfully validated instrument to assess SMUD in adolescents based on the ICD-11 criteria of GD. Thus, it can support early detection in order to prevent symptom aggravation, chronification, and secondary comorbidities. It can contribute to the development of a standardized conceptualization and its two-factorial structure offers promising new insights into the evaluation of SM usage patterns. Further examination including clinical validation is desirable.

Adolescent gaming and social media usage before and during the COVID-19 pandemic

Abstract. Background: The COVID-19 pandemic has raised concerns about a potential increase of addictive behaviors. Adolescents are considered particularly vulnerable to a problematic usage of digital applications. For the first systematic investigation of screen time and problematic usage patterns over the course of the pandemic, a pre-pandemic survey on adolescent social media (SM) and gaming use was extended to a longitudinal study. Here we present the results of the first two measurements points (pre-pandemic/under lockdown). Methods: A representative sample of 1,221 adolescents (10–17 years) participated in an online survey in 09/2019, 824 of them in 04/2020. Prevalence rates were measured at baseline with standardized scales covering ICD-11 criteria for problematic usage patterns. These were statistically compared and related to pre- and under-lockdown screen time. Results: Pre-pandemic prevalence rates for pathological SM/gaming were about 3 % each, for at-risk usage 8–10 % including more boys than girls. Usage frequencies and screen times significantly increased under the lockdown. The predictive value of usage patterns for screen time decreased from before to during the lockdown. Changes in screen time could not be predicted by the usage pattern. Discussion: The stability of the observed rates and effects should be further examined over the course of the pandemic. This will lead to relevant implications for prevention measures and the allocation of intervention resources.

Assessing ICD-11 gaming disorder in adolescent gamers by parental ratings: Development and validation of the Gaming Disorder Scale for Parents (GADIS-P)

BACKGROUND AND AIMS

The addiction to digital games is associated with substantial impairments in daily functioning and adolescents are particularly at risk. Screening instruments for the new ICD-11 diagnosis Gaming Disorder (GD) are rare and only include self-ratings thus far. Since adolescents' insight might be limited due to young age or symptom denial, external ratings are essential. We therefore aimed to develop and validate the Gaming Disorder Scale for Parents (GADIS-P) in a representative sample of parents and young gamers.

METHODS

GADIS-P was developed as an adaptation of a recently published self-rating scale. It was validated in 800 parents and their frequently gaming children between 10 and 17 years with standardized questionnaires in an online survey. Item structure was investigated by confirmatory factorial analysis. Gaming time, pathological gaming according to DSM-5, emotional dysregulation, and academic performance were used to derive criterion validity. Accordance with self-ratings was determined. ROC-Analyses were computed to determine cut-off values.

RESULTS

A presumed two-factorial structure of GADIS-P could be confirmed describing cognitive-behavioral symptoms and negative consequences. The instrument showed good to excellent internal consistency (Cronbach's α = 0.89-0.92, McDonald's ω = 0.92-0.95) and criterion validity with moderate to strong correlations regarding gaming behavior (r/ϱ = 0.35-0.76), excellent discriminatory power, and moderate accordance with the adolescents' self-ratings (kappa = 0.47-0.58).

DISCUSSION AND CONCLUSIONS

As the first successfully validated tool for the assessment of ICD-11 GD in adolescents by parental judgment, GADIS-P can make an important contribution to reliable GD screening in clinical and research settings.

Combinatorial Optimization of Clustering Decisions: An Approach to Refine Psychiatric Diagnoses

Using complete enumeration (e.g., generating all possible subsets of item combinations) to evaluate clustering problems has the benefit of locating globally optimal solutions automatically without the concern of sampling variability. The proposed method is meant to combine clustering variables in such a way as to create groups that are maximally different on a theoretically sound derivation variable(s). After the population of all unique sets is permuted, optimization on some predefined, user-specific function can occur. We apply this technique to optimizing the diagnosis of Alcohol Use Disorder. This is a unique application, from a clustering point of view, in that the decision rule for clustering observations into the "diagnosis" group relies on both the set of items being considered and a predefined threshold on the number of items required to be endorsed for the "diagnosis" to occur. In optimizing diagnostic rules, criteria set sizes can be reduced without a loss of significant information when compared to current and proposed, alternative, diagnostic schemes.

Using Complete Enumeration to Derive "One-Size-Fits-All" Versus "Subgroup-Specific" Diagnostic Rules for Substance Use Disorder

The use of fixed diagnostic rules, whereby the same diagnostic algorithms are applied across all individuals regardless of personal attributes, has been the tradition in the Diagnostic and Statistical Manual of Mental Disorders. This practice of "averaging" across individuals inevitably introduces diagnostic error. Furthermore, these average rules are typically derived through expert consensus rather than through data-driven approaches. Utilizing National Survey on Drug Use and Health 2013 (N = 23, 889), we examined whether subgroup-specific, "customized" alcohol use disorder diagnostic rules, derived using deterministic optimization, perform better than an average, "one-size-fits-all" diagnostic rule. The average solution for the full sample included a set size of six and diagnostic threshold of three. Subgroups had widely varying set sizes (M = 6.870; range = 5-10) with less varying thresholds (M = 2.70; range = 2-4). External validation verified that the customized algorithms performed as well, and sometimes better than, the average solution in the prediction of relevant correlates. However, the average solution still performed adequately with respect to external validators.

Addiction from the harmful dysfunction perspective: How there can be a mental disorder in a normal brain

Is addiction a medical disorder, and if so, what kind of disorder is it? Addiction is considered a brain disease by NIDA, based on observed brain changes in addicts that are interpreted as brain damage. Critics argue that the brain changes result instead from normal neuroplasticity and learning in response to the intense rewards provided by addictive substances, thus addiction is not a disorder but rather a series of normal-range if problematic choices. Relying on the harmful dysfunction analysis of medical disorder to evaluate disorder versus nondisorder status, I argue that even if one accepts the critics' reinterpretation of NIDA's brain evidence and rejects the brain disease account, the critics' conclusion that addiction is not a medical disorder but is rather a matter of problematic nondisordered choice does not follow. This is because there is a further possible account of addiction, the evolutionary "hijack" view, that holds that addiction is due to the availability of substances and stimuli that were unavailable during human species evolution and that coopt certain brain areas concerned with human motivation, creating biologically undesigned peremptory desires. I argue that if the hijack theory is correct, then it opens up the possibility that addiction could be a true motivational medical disorder for which there is no underlying neurological-level dysfunction. Finally, I explore the implications of this account for how we see the social responsibility for addiction and how we attempt to control it.

Abus de substance et DSM-5.0 – Le point sur les controverses

Le DSM-5 (2013) a introduit des changements marqués, notamment concernant les abus de substance. Ces changements font l’objet de controverses qui restent vives. Ainsi les catégories individualisées dans le DSM-IV, abus de substance (dont la validité était contestée) et dépendance (au sens d’une altération du contrôle sur la consommation, conceptualisation qui a permis de justifier l’assimilation de l’addiction à un trouble psychiatrique au lieu de concevoir celle-ci comme une faiblesse morale ou un choix), ont été fusionnées en une seule pathologie, le trouble d’utilisation de substance (TUS), avec 11 symptômes possibles. Un nouveau critère, le désir impérieux ou fort besoin de consommer la substance (craving, l’une des expression phénoménolgique de la perte de contrôle), a été inclus dans cette liste. Or, la validité du nouveau TUS est loin d’être démontrée. En outre, la définition d’un continuum de sévérité (fonction du nombre de critères observés, avec un seuil à deux critères, et six critères ou plus correspondant à une forme sévère), est particulièrement contestée (notamment le seuil bas qui peut entraîner une inflation de la prévalence, car il devient beaucoup plus facile pour un sujet de satisfaire à deux critères seulement). Des données essentielles de la neurobiologie seraient ignorées. Par exemple aucune référence n’est faite au processus de sensibilisation, pourtant reconnu comme fondamental dans les phénomènes addictifs. Lors de cette présentation, basée sur une analyse de la littérature récente, les éléments actuels du débat et les pistes explorées (« DSM-5.1 ») seront discutés.

Assessing ICD-11 Gaming Disorder in Adolescent Gamers: Development and Validation of the Gaming Disorder Scale for Adolescents (GADIS-A)

BACKGROUND

Adolescents affected by Gaming Disorder (GD) show substantial impairments in daily functioning. GD was included in the 11th revision of the International Classification of Diseases (ICD-11) as a new diagnosis coming into effect in January 2022. An instrument to screen for GD in adolescents has not yet been published and is urgently needed for scientific research and clinical practice.

METHODS

In the present study, the ICD-11-based Gaming Disorder Scale for Adolescents (GADIS-A) was developed by clinical experts and scientists. It was validated with 819 frequent gamers of 10 to 17 years and a respective caregiver in an online survey. Criterion validity was examined by assessing gaming behavior, emotional dysregulation, and academic performance. Item structure was investigated by factorial analyses. ROC- and Latent Profile Analyses were computed for differentiation between GD and Non-GD.

RESULTS

In line with the ICD-11 approach and accounting for cognitive-behavioral symptoms and negative consequences equally, GADIS-A items were best described by two factors. The new instrument showed excellent internal consistency, good criterion validity, and excellent discriminatory power.

CONCLUSIONS

GADIS-A is the first successfully validated questionnaire to assess ICD-11 GD in adolescents. Thus, it can significantly contribute to reliably identify affected adolescents in clinical and research settings.

Effects of CYP3A4 Polymorphisms on Drug Addiction Risk Among the Chinese Han Population

Background:Cytochrome P450 3A4 (CYP3A4) regulates pharmacokinetic and pharmacodynamic interactions during the process of drug absorption and metabolism, suggesting CYP3A4 plays an important role in drug addiction. However, the association between CYP3A4 polymorphisms and drug addiction risk is still not clear.

Methods: This case-control study included 504 drug addicts and 501 healthy controls from Xi'an, China. Four single nucleotide polymorphisms (SNP) in CYP3A4 (rs3735451, rs4646440, rs35564277, and rs4646437) were genotyped by Agena MassARRAY platform. After adjusting by age and gender, we calculated odd ratios (OR) and 95% confidence intervals (CI) by logistic regression to estimate the association between CYP3A4 polymorphisms and drug addiction risk.

Results: We found rs4646440 and rs4646437 were associated with decreased risk of drug addiction in codominant (rs4646440: OR = 0.41, 95%CI = 0.19–0.92, p = 0.030; rs4646437: OR = 0.19, 95%CI = 0.04–0.87, p = 0.032) and recessive (rs4646440: OR = 0.41, 95%CI = 0.19–0.91, p = 0.028; rs4646437: OR = 0.20, 95%CI = 0.04–0.90, p = 0.036) models. Rs3735451 and rs4646437 were associated with drug addiction risk in the subgroup of middle-aged people (44 < age ≤ 59) and elderly people (age ≥ 60), individually. For men, rs3735451, rs4646440, and rs4646437 had strong relationship with decreased risk of drug addiction (p < 0.05). The effects of rs3735451 on drug addiction risk were related to drug-using time (p < 0.05). We also observed one block (rs4646440 and rs35564277) in haplotype analysis.

Conclusion:CYP3A4 polymorphisms were associated with drug addiction risk among the Chinese Han population.

Toward more efficient diagnostic criteria sets and rules: The use of optimization approaches in addiction science

Psychiatric diagnostic systems, such as The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), use expert consensus to determine diagnostic criteria sets and rules (DCSRs), rather than exploiting empirical techniques to arrive at optimal solutions (OS). Our project utilizes complete enumeration (i.e., generating all possible subsets of item combinations A and B with all possible thresholds, T) to evaluate all possible DCSRs given a set of relevant diagnostic data. This method yields the entire population distribution of diagnostic classifications (i.e., diagnosis of the disorder versus no diagnosis) produced by a set of dichotomous predictors (i.e., diagnostic criteria). Once unique sets are enumerated, optimization on some predefined correlate or predictor will maximally separate diagnostic groups on one or more, disorder-specific "outcome" criteria. We used this approach to illustrate how to create a common Substance Use Disorder (SUD) DCSR that is applicable to multiple substances. We demonstrate the utility of this approach with respect to alcohol use disorder and Cannabis Use Disorder (CUD) using DSM-5 criteria as input variables. The optimal SUD solution with a moderate or above severity grading included four criteria (i.e. 1) having a strong urge or craving for the substance (CR), 2) failure to fulfill major role obligations at work school or home (FF), 3) continued use of the substance despite social or interpersonal problems caused by the substance use (SI) and 4) physically hazardous use (HU)) with a diagnostic threshold of two. The derived DCSR was validated with known correlates of SUD and performed as well as DSM-5. Our findings illustrate the value of using an empirical approach to what is typically a subjective process of choosing criteria and algorithms that is prone to bias. The optimization of diagnostic criteria can reduce criteria set sizes, resulting in decreased research, clinician, and patient burden.

Deriving alternative criteria sets for alcohol use disorders using statistical optimization: Results from the National Survey on Drug Use and Health

Much of the foundation of clinical practice, psychiatric epidemiology, and research into the etiology, course, prevention, and treatment of alcohol use disorder (AUD) rests on psychiatric diagnosis. However, existing research has failed to adequately exploit empirical techniques and existing databases to derive criteria considered optimal with respect to predicting external correlates. The current project adopts a novel approach to deriving new diagnostic criteria sets and rules for AUD. Utilizing the 2010 (N = 24,120) and 2013 (N = 23,627) National Survey on Drug Use and Health (NSDUH; Substance Abuse and Mental Health Services Administration [SAMHSA], 2011, 2014) data sets, we performed a statistical optimization procedure, using complete enumeration, on participants 21 or older who had consumed at least 1 alcoholic beverage in the past year. The goal was to maximize the distance (based on Cohen's d) between mean levels of the optimization criteria (i.e., consumption and functional impairment) in those with an AUD diagnosis versus those without. In contrast with current convention, AUD is derived transparently using a data-driven approach. The best solution included 9 criteria with a diagnostic threshold of 3, while the second-best solution comprised 5 criteria with a threshold of 2. External validation demonstrated both solutions perform similarly, suggesting it is appropriate to use either, depending on the goal of the diagnosis. Overall, statistical optimization approaches can yield highly efficient criteria sets and rules, although multiple, near equivalently performing solutions can be generated. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Beyond the myths about work addiction: Toward a consensus on definition and trajectories for future studies on problematic overworking

In an unprecedented collaborative effort to integrate the existing knowledge on work addiction and delineate trajectories for future studies, several papers from work addiction researchers (including some of the most prolific experts in the field) have contributed to the debate on the misconceptions/myths about this problematic behavior. On the basis of the overview of the presented arguments, the most commonly proposed recommendations were that there should be: (a) a general definition of work addiction, (b) the need for more transdisciplinary and integrative approach to research, and (c) propositions regarding more high-quality research. These three aspects are summarized in the present paper. There is a general agreement among work addiction researchers that work addiction is a problematic behavior that merits more systematic studies, which require input and expertise from a wide range of fields due to its complex nature.

Melatonin in drug addiction and addiction management: Exploring an evolving multidimensional relationship

Melatonin is a pleiotropic signalling molecule that regulates several physiological functions, and synchronises biological rhythms. Recent evidences are beginning to reveal that a dysregulation of endogenous melatonin rhythm or action may play a larger role in the aetiology and behavioural expression of drug addiction, than was previously considered. Also, the findings from a number of animal studies suggest that exogenous melatonin supplementation and therapeutic manipulation of melatonin/melatonin receptor interactions may be beneficial in the management of behavioural manifestations of drug addiction. However, repeated exogenous melatonin administration may cause a disruption of its endogenous rhythm and be associated with potential drawbacks that might limit its usefulness. In this review, we examine the roles of melatonin and its receptors in addictive behaviours; discussing how our understanding of melatonin’s modulatory effects on the brain rewards system and crucial neurotransmitters such as dopamine has evolved over the years. Possible indications(s) for melatonergic agents in addiction management, and how manipulations of the endogenous melatonin system may be of benefit are also discussed. Finally, the potential impediments to application of melatonin in the management of addictive behaviours are considered.

When addiction symptoms and life problems diverge: a latent class analysis of problematic gaming in a representative multinational sample of European adolescents

The proposed diagnosis of Internet gaming disorder (IGD) in DSM-5 has been criticized for "borrowing" criteria related to substance addiction, as this might result in misclassifying highly involved gamers as having a disorder. In this paper, we took a person-centered statistical approach to group adolescent gamers by levels of addiction-related symptoms and gaming-related problems, compared these groups to traditional scale scores for IGD, and checked how groups were related to psychosocial well-being using a preregistered analysis plan. We performed latent class analysis and regression with items from IGD and psychosocial well-being scales in a representative sample of 7865 adolescent European gamers. Symptoms and problems matched in only two groups: an IGD class (2.2%) having a high level of symptoms and problems and a Normative class (63.5%) having low levels of symptoms and problems. We also identified two classes comprising 30.9% of our sample that would be misclassified based on their report of gaming-related problems: an Engaged class (7.3%) that seemed to correspond to the engaged gamers described in previous literature, and a Concerned class (23.6%) reporting few symptoms but moderate to high levels of problems. Our findings suggest that a reformulation of IGD is needed. Treating Engaged gamers as having IGD when their poor well-being might not be gaming related may delay appropriate treatment, while Concerned gamers may need help to reduce gaming but would not be identified as such. Additional work to describe the phenomenology of these two groups would help refine diagnosis, prevention and treatment for IGD.

Gamers' insights into the phenomenology of normal gaming and game "addiction": A mixed methods study

In response to calls for further research into the phenomenology of Internet gaming disorder (IGD), we used a community-engaged consensus development approach to evaluate how members of the "gamer culture" describe problematic gaming and the relationship of these descriptions to the proposed IGD criteria. Two focus groups of gamers were recruited at a video game convention. Participants were asked to submit suggestions for signs of game "addiction". Participants discussed and ranked the criteria in order of conceptual importance. The rankings were analyzed quantitatively, and then a multidisciplinary team compared the ranked criteria to the DSM-5 IGD proposed criteria. The strongest agreement between participants' rankings and IGD symptomatology was found for harms/functional impairment due to gaming, continued use despite problems, unsuccessful attempts to control gaming, and loss of interest in previous hobbies and entertainment. There was less support for other IGD criteria. Participants also offered new content domains. These findings suggest that collaborative knowledge-building approaches may help researchers and policymakers understand the characteristics and processes specific to problematic video game play and improve content validity of IGD criteria. Future efforts may benefit from multi-stakeholder approaches to refine IGD criteria and inform theory, measurement and intervention.

The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations

This article provides an overview of the history of substance use and misuse and chronicles the long shared history humans have had with psychoactive substances, including alcohol. The practical and personal functions of substances and the prevailing views of society towards substance users are described for selected historical periods and within certain cultural contexts. This article portrays how the changing historical and cultural milieu influences the prevailing medical, moral, and legal conceptualizations of substance use as reflected both in popular opinion and the consensus of the scientific community and represented by the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). Finally, this article discusses the efforts to classify substance use disorders (SUDs) and associated psychopathology in the APA compendium. Controversies both lingering and resolved in the field are discussed, and implications for the future of SUD diagnoses are identified.

Diagnostic Issues and Controversies in DSM-5: Return of the False Positives Problem

The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was the most controversial in the manual's history. This review selectively surveys some of the most important changes in DSM-5, including structural/organizational changes, modifications of diagnostic criteria, and newly introduced categories. It analyzes why these changes led to such heated controversies, which included objections to the revision's process, its goals, and the content of altered criteria and new categories. The central focus is on disputes concerning the false positives problem of setting a valid boundary between disorder and normal variation. Finally, this review highlights key problems and issues that currently remain unresolved and need to be addressed in the future, including systematically identifying false positive weaknesses in criteria, distinguishing risk from disorder, including context in diagnostic criteria, clarifying how to handle fuzzy boundaries, and improving the guidelines for "other specified" diagnosis.

Sex differences in drug addiction and response to exercise intervention: From human to animal studies

Accumulated research supports the idea that exercise could be an option of potential prevention and treatment for drug addiction. During the past few years, there has been increased interest in investigating of sex differences in exercise and drug addiction. This demonstrates that sex-specific exercise intervention strategies may be important for preventing and treating drug addiction in men and women. However, little is known about how and why sex differences are found when doing exercise-induced interventions for drug addiction. In this review, we included both animal and human that pulled subjects from a varied age demographic, as well as neurobiological mechanisms that may highlight the sex-related differences in these potential to assess the impact of sex-specific roles in drug addiction and exercise therapies.

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

PURPOSE

The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking.

METHOD

NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized.

RESULT

The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers.

CONCLUSIONS

Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.