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Validity of the DSM-5 craving criterion for alcohol, tobacco, cannabis, cocaine, heroin, and non-prescription use of prescription painkillers (opioids)

Published online by Cambridge University Press:  01 November 2021

D. Shmulewitz ,
M. Stohl ,
E. Greenstein ,
S. Roncone ,
C. Walsh ,
E. Aharonovich ,
M. M. Wall  and
D. S. Hasin Open the ORCID record for D. S. Hasin [Opens in a new window]
D. Shmulewitz
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
M. Stohl
Affiliation:
New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
E. Greenstein
Affiliation:
New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
S. Roncone
Affiliation:
New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
C. Walsh
Affiliation:
New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
E. Aharonovich
Affiliation:
New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
M. M. Wall
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
D. S. Hasin*
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
*
Author for correspondence: Deborah S. Hasin, E-mail: deborah.hasin@gmail.com; dsh2@columbia.edu
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Abstract

Background

Although the DSM-5 was adopted in 2013, the validity of the new substance use disorder (SUD) diagnosis and craving criterion has not been investigated systematically across substances.

Methods

Adults (N = 588) who engaged in binge drinking or illicit drug use and endorsed at least one DSM-5 SUD criterion were included. DSM-5 SUD criteria were assessed for alcohol, tobacco, cannabis, cocaine, heroin, and opioids. Craving was considered positive if “wanted to use so badly that could not think of anything else” (severe craving) or “felt a very strong desire or urge to use” (moderate craving) was endorsed. Baseline information on substance-related variables and psychopathology was collected, and electronic daily assessment queried substance use for the following 90 days. For each substance, logistic regression estimated the association between craving and validators, i.e. variables expected to be related to craving/SUD, and whether association with the validators differed for DSM-5 SUD diagnosed with craving as a criterion v. without.

Results

Across substances, craving was associated with most baseline validators (p values<0.05); neither moderate nor severe craving consistently showed greater associations. Baseline craving predicted subsequent use [odds ratios (OR): 4.2 (alcohol) – 234.3 (heroin); p's ⩽ 0.0001], with stronger associations for moderate than severe craving (p's < 0.05). Baseline DSM-5 SUD showed stronger associations with subsequent use when diagnosed with craving than without (p's < 0.05).

Conclusion

The DSM-5 craving criterion as operationalized in this study is valid. Including craving improves the validity of DSM-5 SUD diagnoses, and clinical relevance, since craving may cause impaired control over use and development and maintenance of SUD.

Keywords

Concurrent validitycraving criterionDSM-5prospective validitysubstance use disorder
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 5 , April 2023 , pp. 1955 - 1969
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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