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Addiction. 2018 Oct 29. doi: 10.1111/add.14482. [Epub ahead of print]

Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems: analysis of data from the WHO's World Mental Health Surveys.

Author information

1
National Drug and Alcohol Research Centre (NDARC), UNSW, Sydney, Australia.
2
School of Medicine (Psychology), University of Tasmania, Hobart, Australia.
3
Department of Epidemiology, Services, and Prevention Research (DESPR), National Institute on Drug Abuse (NIDA), National Institute of Health (NIH), Bethesda, Maryland, USA.
4
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
5
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA.
6
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.
7
CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
8
Pompeu Fabra University (UPF), Barcelona, Spain.
9
Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
10
School of Psychology, Ulster University, Londonderry, United Kingdom.
11
Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
12
Anxiety Disorders Center, Buenos Aires, Argentina.
13
Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
14
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon.
15
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon.
16
Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.
17
Ibn Sina Teaching Hospital, Alshifaa, Mosul, Iraq.
18
Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia.
19
Queensland Brain Institute, The University of Queensland, St Lucia, Australia.
20
National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.
21
Institute of Psychiatry and Neurology, Warsaw, Poland.
22
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong.
23
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
24
Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud, Murcia, Spain.
25
IMIB-Arrixaca, Murcia, Spain.
26
CIBER de Epidemiología y Salud Pública (CIBERESP), Murcia, Spain.
27
National School of Public Health, Management and Professional Development Bucharest, Romania.
28
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand.
29
Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia.
30
Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
31
Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland.

Abstract

BACKGROUND AND AIMS:

The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups.

DESIGN:

Cross-sectional household surveys.

SETTING:

Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative.

PARTICIPANTS:

Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users.

MEASUREMENTS:

Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI).

FINDINGS:

Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5-22.6%) and 7.0% (6.4-7.7%), respectively. Among cannabis users, 9.3% (7.4-11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3-4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ ≥ 0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use ('harm to others'). Minimal variation in clinical features was observed across diagnostic systems.

CONCLUSIONS:

The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported 'harm to others' is questionable.

KEYWORDS:

Alcohol; DSM; ICD; World Mental Health Surveys; cannabis; diagnosis; substance use disorder

PMID:
30370636
DOI:
10.1111/add.14482

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