Background: Assessments of DSM-IV and DSM-5 criteria with sample populations of opioid users are limited. This study aimed to determine the number of latent classes in opioid users and assessment of the proposed revisions to the DSM-5 opioid use disorder (OUD) criteria. Methods: Data came from the 2011 Iranian National Mental Health Survey (IranMHS) on 7,886 participants aged 15-64 years living in Iran. We used the Composite International Diagnostic Interview (CIDI) version 2.1 in all respondents who indicated using opioids at least 5 times in the previous 12 months (n = 236). Results: A three-class model provided the best fit of all the models tested. Classes showed a spectrum of severity that was compatible with the DSM-5 classification. ‘Legal problems' and ‘desire to cut down' showed poor discrimination between classes. The weighted prevalence of OUD using DSM-5 was 20.7% higher than with DSM-IV. Conclusions: Results support the grouping based on severity of symptoms, combining abuse and dependence into a single diagnosis, omitting legal problems, and addition of craving as a new criterion.

Keywords:
DSM-5, DSM-IV, ICD-10, Diagnosis, Opiate dependence, Opioid-related disorders, Iran
1.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Press, 1994.
2.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 5. Arlington, American Psychiatric Publishing, 2013.
3.
Beseler C, Jacobson KC, Kremen WS, Lyons MJ, Glatt SJ, Faraone SV, Gillespie NA, Tsuang MT: Is there heterogeneity among syndromes of substance use disorder for illicit drugs? Addict Behav 2006;31:929-947.
4.
Blanco C, Harford TC, Nunes E, Grant B, Hasin D: The latent structure of marijuana and cocaine use disorders: results from the National Longitudinal Alcohol Epidemiologic Survey (NLAES). Drug Alcohol Depend 2007;91:91-96.
5.
Muthen BO, Grant B, Hasin D: The dimensionality of alcohol abuse and dependence: factor analysis of DSM-III-R and proposed DSM-IV criteria in the 1988 National Health Interview Survey. Addiction 1993;88:1079-1090.
6.
Teesson M, Lynskey M, Manor B, Baillie A: The structure of cannabis dependence in the community. Drug Alcohol Depend 2002;68:255-262.
7.
Gelhorn H, Hartman C, Sakai J, Stallings M, Young S, Rhee SH, Corley R, Hewitt J, Hopfer C, Crowley T: Toward DSM-V: an item response theory analysis of the diagnostic process for DSM-IV alcohol abuse and dependence in adolescents. J Am Acad Child Adolesc Psychiatry 2008;47:1329-1339.
8.
Harford TC, Yi HY, Faden VB, Chen CM: The dimensionality of DSM-IV alcohol use disorders among adolescent and adult drinkers and symptom patterns by age, gender, and race/ethnicity. Alcohol Clin Exp Res 2009;33:868-878.
9.
Gillespie NA, Neale MC, Prescott CA, Aggen SH, Kendler KS: Factor and item-response analysis DSM-IV criteria for abuse of and dependence on cannabis, cocaine, hallucinogens, sedatives, stimulants and opioids. Addiction 2007;102:920-930.
10.
Hasin DS, Fenton MC, Beseler C, Park JY, Wall MM: Analyses related to the development of DSM-5 criteria for substance use related disorders: 2. Proposed DSM-5 criteria for alcohol, cannabis, cocaine and heroin disorders in 663 substance abuse patients. Drug Alcohol Depend 2012;122:28-37.
11.
Beseler CL, Hasin DS: Cannabis dimensionality: dependence, abuse and consumption. Addict Behav 2010;35:961-969.
12.
Piontek D, Kraus L, Legleye S, Buhringer G: The validity of DSM-IV cannabis abuse and dependence criteria in adolescents and the value of additional cannabis use indicators. Addiction 2011;106:1137-1145.
13.
Compton WM, Saha TD, Conway KP, Grant BF: The role of cannabis use within a dimensional approach to cannabis use disorders. Drug Alcohol Depend 2009;100:221-227.
14.
Wu LT, Pan JJ, Blazer DG, Tai B, Brooner RK, Stitzer ML, Patkar AA, Blaine JD: The construct and measurement equivalence of cocaine and opioid dependences: a National Drug Abuse Treatment Clinical Trials Network (CTN) study. Drug Alcohol Depend 2009;103:114-123.
15.
McBride O, Strong DR, Kahler CW: Exploring the role of a nicotine quantity-frequency use criterion in the classification of nicotine dependence and the stability of a nicotine dependence continuum over time. Nicotine Tob Res 2010;12:207-216.
16.
Saha TD, Compton WM, Pulay AJ, Stinson FS, Ruan WJ, Smith SM, Grant BF: Dimensionality of DSM-IV nicotine dependence in a national sample: an item response theory application. Drug Alcohol Depend 2010;108:21-28.
17.
Kerridge BT, Saha TD, Smith S, Chou PS, Pickering RP, Huang B, Ruan JW, Pulay AJ: Dimensionality of hallucinogen and inhalant/solvent abuse and dependence criteria: implications for the diagnostic and statistical manual of mental disorders-fifth edition. Addict Behav 2011;36:912-918.
18.
Saha TD, Compton WM, Chou SP, Smith S, Ruan WJ, Huang B, Pickering RP, Grant BF: Analyses related to the development of DSM-5 criteria for substance use related disorders: 1. toward amphetamine, cocaine and prescription drug use disorder continua using Item Response Theory. Drug Alcohol Depend 2012;122:38-46.
19.
Shand FL, Slade T, Degenhardt L, Baillie A, Nelson EC: Opioid dependence latent structure: two classes with differing severity? Addiction 2011;106:590-598.
20.
Monga N, Rehm J, Fischer B, Brissette S, Bruneau J, El-Guebaly N, Noel L, Tyndall M, Wild C, Leri F, Fallu JS, Bahl S: Using latent class analysis (LCA) to analyze patterns of drug use in a population of illegal opioid users. Drug Alcohol Depend 2007;88:1-8.
21.
Chung T, Martin CS: Classification and short-term course of DSM-IV cannabis, hallucinogen, cocaine, and opioid disorders in treated adolescents. J Consult Clin Psychol 2005;73:995-1004.
22.
Lynskey MT, Agrawal A, Bucholz KK, Nelson EC, Madden PA, Todorov AA, Grant JD, Martin NG, Heath AC: Subtypes of illicit drug users: a latent class analysis of data from an Australian twin sample. Twin Res Hum Genet 2006;9:523-530.
23.
Wu LT, Woody GE, Yang C, Blazer DG: Subtypes of nonmedical opioid users: results from the national epidemiologic survey on alcohol and related conditions. Drug Alcohol Depend 2010;112:69-80.
24.
Martin CS, Chung T, Langenbucher JW: How should we revise diagnostic criteria for substance use disorders in the DSM-V? J Abnorm Psychol 2008;117:561-575.
25.
Hasin DS: Commentary on Shand et al. (2011): opioid use disorder as a condition of graded severity, similar to other substance use disorders. Addiction 2011;106:599-600.
26.
Langenbucher JW, Chung T: Onset and staging of DSM-IV alcohol dependence using mean age and survival-hazard methods. J Abnorm Psychol 1995;104:346-354.
27.
Martin CS, Langenbucher JW, Kaczynski NA, Chung T: Staging in the onset of DSM-IV alcohol symptoms in adolescents: survival/hazard analyses. J Stud Alcohol 1996;57:549-558.
28.
Grant BF, Stinson FS, Harford T: The 5-year course of alcohol abuse among young adults. J Subst Abuse 2001;13:229-238.
29.
Shmulewitz D, Keyes K, Beseler C, Aharonovich E, Aivadyan C, Spivak B, Hasin D: The dimensionality of alcohol use disorders: results from Israel. Drug Alcohol Depend 2010;111:146-154.
30.
Peer K, Rennert L, Lynch KG, Farrer L, Gelernter J, Kranzler HR: Prevalence of DSM-IV and DSM-5 alcohol, cocaine, opioid, and cannabis use disorders in a largely substance dependent sample. Drug Alcohol Depend 2013;127:215-219.
31.
Keyes KM, Krueger RF, Grant BF, Hasin DS: Alcohol craving and the dimensionality of alcohol disorders. Psychol Med 2011;41:629-640.
32.
Saha TD, Chou SP, Grant BF: Toward an alcohol use disorder continuum using item response theory: results from the national epidemiologic survey on alcohol and related conditions. Psychol Med 2006;36:931-941.
33.
Saha TD, Stinson FS, Grant BF: The role of alcohol consumption in future classifications of alcohol use disorders. Drug Alcohol Depend 2007;89:82-92.
34.
Proctor SL, Kopak AM, Hoffmann NG: Compatibility of current DSM-IV and proposed DSM-5 diagnostic criteria for cocaine use disorders. Addict Behav 2012;37:722-728.
35.
Hasin D, Paykin A: Dependence symptoms but no diagnosis: diagnostic ‘orphans' in a 1992 national sample. Drug Alcohol Depend 1999;53:215-222.
36.
Schuckit MA, Danko GP, Smith TL, Hesselbrock V, Kramer J, Bucholz K: A 5-year prospective evaluation of DSM-IV alcohol dependence with and without a physiological component. Alcohol Clin Exp Res 2003;27:818-825.
37.
Harford TC, Yi HY, Grant BF: The five-year diagnostic utility of ‘diagnostic orphans' for alcohol use disorders in a national sample of young adults. J Stud Alcohol Drugs 2010;71:410-417.
38.
McBride O, Adamson G: Are subthreshold alcohol dependence symptoms a risk factor for developing DSM-IV alcohol use disorders? A three-year prospective study of ‘diagnostic orphans' in a national sample. Addict Behav 2010;35:586-592.
39.
Agrawal A, Heath AC, Lynskey MT: DSM-IV to DSM-5: the impact of proposed revisions on diagnosis of alcohol use disorders. Addiction 2011;106:1935-1943.
40.
World Health Organization: The ICD-10 Classification of Mental and Behavioural disorders: Diagnostic Criteria for Research. Geneva, World Health Organization, 1993.
41.
Mewton L, Slade T, McBride O, Grove R, Teesson M: An evaluation of the proposed DSM-5 alcohol use disorder criteria using Australian national data. Addiction 2011;106:941-950.
42.
Grant JD, Scherrer JF, Neuman RJ, Todorov AA, Price RK, Bucholz KK: A comparison of the latent class structure of cannabis problems among adult men and women who have used cannabis repeatedly. Addiction 2006;101:1133-1142.
43.
United Nations Office on Drugs and Crime: World Drug Report. Vienna, UNODC, 2011.
44.
Arabgol F, Alaghband-rad J, Sharifi V, Hakim Shooshtari M, Shabaani A, Davari Ashtiani R, Shahrivar Z, Shirazi E, Amini H, Kaviani H: Reliability of a Persian translation of the Composite International Diagnostic Interview (CIDI), section for substance use disorders: in a multi-center study in Iran (In Persian). Adv Cogn Sci 2005;7:45-54.
45.
Tarrahi MJ, Rahimi-Movaghar A, Zeraati H, Amin-Esmaeili M, Motevalian A, Hajebi A, Sharifi V, Radgoodarzi R, Hefazi M, Fotouhi A: Agreement between DSM-IV and ICD-10 criteria for opioid use disorders in two Iranian samples. Addict Behav 2014;39:553-557.
46.
Rahimi-Movaghar A, Amin-Esmaeili M, Sharifi V, Hajebi A, Hefazi M, Rad Goodarzi R, Motevalian SA: The Iranian Mental Health Survey: design and field procedures. Iran J Psychiatry 2014;9:125-132.
47.
Collins LM, Lanza ST: Latent Class and Latent Transition Analysis: With Applications in the Social, Behavioral and Health Sciences. New York, Wiley, 2010.
48.
R Development Core Team: R: A Language and Environment for Statistical Computing. Vienna, R Foundation for Statistical Computing, 2009.
49.
Farhoudian A, Sadeghi M, Vishteh HRK, Moazen B, Fekri M, Rahimi-Movaghar A: Component analysis of Iranian crack; a newly abused narcotic substance in Iran. Iran J Pharm Res 2014;13:337-344.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.