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
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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.
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The ratings were not based on empirical evidence, as there has been only a small number of studies comparing ICD-11 CDDG and DSM-5 criteria for a particular disorder in terms of whether they identify the same people or yield similar prevalence estimates.
“These ratings were not based on empirical evidence, as there has been only a small number of studies comparing the ICD-11 CDDG and DSM-5 criteria for a particular disorder in terms of whether they are identifying the same people or yield similar prevalence estimates 25,26 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [26]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredDifferences in diagnostic criteria between ICD and DSM contribute to discrepancies in estimated prevalence of SUDs.
“Differences in diagnostic crite ria between the ICD and DSM contribute to some of the discrep ancies in the estimated prevalence of SUDs 21 .”
From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [21]
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- Authors
- Degenhardt, L., Bharat, C., Bruno, R., Glantz, M. D., Sampson, N. A., Lago, L., Aguilar‐Gaxiola, S., Alonso, J., Andrade, L. H., Bunting, B., Caldas‐de‐Almeida, J. M., Cia, A. H., Gureje, O., Karam, E. G., Khalaf, M., McGrath, J. J., Moskalewicz, J., Lee, S., Mneimneh, Z., Navarro‐Mateu, F., Sasu, C. C., Scott, K., Torres, Y., Poznyak, V., Chatterji, S., Kessler, R. C., & Collaborators, O. B. O. T. W. W. M. H. S.
- Affiliations
- UNSW Sydney (AU)
- University of Tasmania (AU)
- National Institutes of Health (US)
- Harvard University (US)
- UC Davis Health (US)
- Universitat Pompeu Fabra (ES)
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (BR)
- University of Ulster (GB)
- 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
- Anxiety Disorders Center Buenos Aires Argentina
- University College Hospital, Ibadan (NG)
- University of Balamand (LB)
- University of Mosul (IQ)
- The University of Queensland (AU)
- Institute of Psychiatry and Neurology (PL)
- Chinese University of Hong Kong (HK)
- University of Michigan (US)
- Instituto Murciano de Investigación Biosanitaria (ES)
- National School of Public Health, Management and Professional Development (RO)
- University of Otago (NZ)
- Universidad CES (CO)
- World Health Organization (CH)
- Corresponding author
- Degenhardt, Louisa
- ORCID
- Degenhardt, Louisa
- Bharat, Chrianna
- Bruno, Raimondo
- Glantz, Meyer D.
- Sampson, Nancy A.
- Lago, Luise
- Aguilar‐Gaxiola, Sergio
- Alonso, Jordi
- Andrade, Laura Helena
- Bunting, Brendan
- Gureje, Oye
- Karam, Elie G.
- McGrath, John J.
- Moskalewicz, Jacek
- Mneimneh, Zeina
- Navarro‐Mateu, Fernando
- Scott, Kate
- Torres, Yolanda
- Poznyak, Vladimir
- Chatterji, Somnath
- Kessler, Ronald C.
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2018-12-09
- Volume
- 114
- Issue
- 3
- Pages
- 534-552
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC7059958
- OpenAlex
- W2898700233
- Cited by
- 60
- References
- 43
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 15 · 2023: 7 · 2022: 4 · 2021: 11 · 2020: 8 · 2019: 7 · 2018: 1
- FWCI
- 5.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- PubMed Central (acceptedVersion)
- UTAS Research Repository (submittedVersion)
- Figshare (submittedVersion)
- SUMA (Spanish Federation of Mathematics Teachers' Societies (FESPM)) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Lirias (KU Leuven) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- National Health and Medical Research Council (1081984)
- World Health Organization
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- alcoholism, cannabis use disorder, ICD-11, diagnostic agreement, ICD-10, DSM-IV, DSM-5, substance dependence, prevalence, harm to others, diagnostic classification systems, World Mental Health Survey Initiative, Composite International Diagnostic Interview, general population survey, cross-national comparison, harm reduction
- MeSH terms
- Alcoholism, Argentina, Australia, Brazil, Marijuana Abuse, Colombia, Cross-Sectional Studies, Humans, Iraq, Northern Ireland, Poland, Portugal, Surveys and Questionnaires, Romania, Spain, World Health Organization, Substance-Related Disorders, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders
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