DIAGNOSTIC CONCORDANCE OF SUBSTANCE USE DISORDERS IN DSM-III, DSR-IV AND ICD-10

Diagnostic concordance of DSM-III, DSM-IV and ICD-10 was tested in a h eterogeneous unrestricted sample of 370 clinical cases drawn from a re gional consortium. Agreement for abuse/harmful use, dependence, and th e collapsed category of 'any diagnosis' was studied across eight drug classes. A probabilistic approach to the cross-classifications based o n configural frequency analysis was applied, permitting the computatio n of four indices of agreement. In contrast to earlier studies, ICD-10 appeared to be the most inclusive system, and often diagnosed cases t hat were undiagnosed by both DSMs. Generally satisfactory coherence be tween the ICD-10 harmful use category and the DSM category of abuse wa s found, but this agreement was often due to a preponderance of negati ve or undiagnosed cases; disagreement was common on which cases in par ticular warrant a mild diagnosis. In general, the greatest diagnostic concordance was observed for sedative/hypnotics, opiates and alcohol, the poorest for amphetamines, cocaine and PCP. The analytic approach p roduced an array of cross-system relationships that are more complex a nd conditional than those previously reported, and scientists and clin icians are cautioned to study particular drugs, diagnostic levels and measures of concordance before applying cross-system results to their own data or design needs.