Test-retest reliability of DSM-5 substance disorder measures as assessed with the PRISM-5, a clinician-administered diagnostic interview
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Aim In DSM-5, the definitions of substance use disorders (SUD) were changed considerably, yet little is known about the reliability of DSM-5 SUD and its new features.Methods The test-retest reliability of DSM-5 SUD and DSM-IV substance dependence (SD) was evaluated in 565 adult substance users, each interviewed twice by different clinician interviewers using the semi-structured Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 version (PRISM-5). DSM-5 SUD and DSM-IV SD criteria were assessed for past year and lifetime, yielding diagnoses and severity levels for alcohol, tobacco, cannabis, cocaine, heroin, opioids, sedatives, hallucinogen, and stimulant use disorders. Cohen's and intraclass correlation coefficients (ICC) assessed reliability for categorical and graded outcomes, respectively. Factors potentially influencing reliability were explored, including inpatient vs. community participant, days between interviews gender, age, race/ethnicity, and SUD severity.Results DSM-5 SUD diagnoses had substantial to excellent reliability for most substances (κ = 0.63-0.94), and moderate for others (hallucinogens, stimulants, sedatives; κ = 0.50-0.59). For graded outcomes (DSM-5 SUD mild, moderate, severe; criteria count 0-11), reliability was substantial to excellent (ICC = 0.74-0.99). Comparisons of DSM-5 SUD and DSM-IV SD reliability showed few significant differences. Reliability of the DSM-5 craving criterion was excellent for heroin (κ = 0.84-0.95) and moderate to substantial for other substances (κ = 0.49-0.76). The only factor influencing reliability of SUD was severity, with milder disorders significantly more likely to be discordant between the interviews.Conclusion Reproducibility is crucial to good measurement. In a large sample using rigorous methodology, diagnoses and dimensional measures from clinician-administered interviews for DSM-5 SUD were generally highly reliable.
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DSM-5 SUD diagnoses showed greater reliability than DSM-IV diagnoses of abuse or dependence.
“DSM-5 SUD diagnoses showed greater reliability than DSM-IV diagnoses of abuse or dependence [33,34].”
From Treatment Use Among U.S. Adults with a Substance Use Disorder: Associations with Symptom Severity, Problem Self-Perception, Comorbid Mental Illness, and Mental Health Treatment (2025) · cites this paper as [34]
The Introduction says DSM-IV abuse was less reliable than dependence, which lends support to the abuse portion of the claim. But the Discussion reports few significant differences between DSM-5 SUD and DSM-IV dependence diagnoses and concludes there was little meaningful difference—not greater reliability for DSM-5. (LLM, conf=0.86)
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“DSM-5 SUD diagnoses showed greater reliability than DSM-IV diagnoses of abuse or dependence [33,34].”
- Authors
- Hasin, D., Shmulewitz, D., Stohl, M., Greenstein, E., Roncone, S., Aharonovich, E., & Wall, M.
- Affiliations
- Columbia University Irving Medical Center (US)
- New York State Psychiatric Institute (US)
- Corresponding author
- Hasin, Deborah
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2020-11
- Volume
- 216
- Pages
- 108294
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC7663179
- OpenAlex
- W3086216102
- Cited by
- 31
- References
- 59
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 8 · 2023: 7 · 2022: 4 · 2021: 6
- FWCI
- 3.04
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- New York State Psychiatric Institute
- National Institute on Drug Abuse (R01DA018652)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
- Keywords
- test-retest reliability, addiction severity, craving, interobserver agreement, alcoholism, opioid use disorder, cannabis use disorder, stimulant use disorder, sedative use disorder, tobacco use disorder
- MeSH terms
- Adult, Female, Health Personnel, Humans, Interview, Psychological, Male, Middle Aged, Reproducibility of Results, Substance-Related Disorders, Diagnostic and Statistical Manual of Mental Disorders, Drug Users
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