Aim

To examine differences in the psychometric characteristics of diagnostic criteria for Substance Use Disorders (SUD) between substance users in harm reduction settings (HR) and substance users seeking treatment (Tx).

Methods

Differential Item and Test Functioning (DIF & DTF) analysis were performed to examine differences in the difficulty of endorsement and in discrimination of the 11 diagnostic criteria and to test if the criteria set as a whole (the “test”) functioned differently by care settings (Tx vs. HR) for alcohol, cocaine, cannabis, opiates and tobacco. To test uniform and nonuniform DIF, multiple indicator multiple cause (MIMIC) structural equation models were used.

Results

Regardless of the substance, the DSM-5 criteria “craving”, “large amount”, “time spent”, “tolerance” and “activities given up” had similar functioning by care settings. Little evidence for DIF was found for other criteria. The criteria set as a whole did not function differently by care settings for alcohol, cocaine and tobacco. At the same trait severity, compared to HR, the Tx subgroup had a greater number of endorsed criteria for cannabis and a smaller number of endorsed criteria for opioids.

Conclusion

The unidimensionality of the 11 DSM-5 criteria and applicability of all criteria and diagnosis was confirmed in this large sample of problematic substance users. While the majority of the criteria related to loss of control of substance use, functioned well in both care settings, the criteria related to consequences of substance use had several differential functioning.

中文翻译：

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DSM-5物质使用失调标准是否因用户护理设置而异？项目响应理论分析方法

目标

在减低危害设置（HR）中的药物使用者与寻求治疗的药物使用者（Tx）之间，检查物质使用障碍（SUD）诊断标准的心理计量学特征的差异。

方法

进行了差异项目和测试功能（DIF和DTF）分析，以检验认可难度和11种诊断标准的区分差异，并测试整个标准设置（“测试”）是否因护理设置而功能不同（Tx vs. HR）用于酒精，可卡因，大麻，阿片和烟草。为了测试一致和不一致的DIF，使用了多指标多原因（MIMIC）结构方程模型。

结果

不论物质如何，DSM-5的标准“渴望”，“大量”，“花费的时间”，“耐受性”和“放弃的活动”在护理环境下具有相似的功能。其他标准的DIF证据很少。整体而言，酒精，可卡因和烟草的护理设置没有任何不同。与HR相比，在同一性状严重程度下，Tx亚组对大麻的认可标准数量较多，对阿片类药物的认可标准数量较少。

结论

在这个有问题的物质使用者的大样本中，证实了11个DSM-5标准的一维性以及所有标准和诊断的适用性。虽然大多数与药物滥用控制失去联系的标准在两种护理环境中均能很好地发挥作用，但与药物滥用后果有关的标准却具有几种不同的功能。