Luise P Lago

Concordance of ICD-11 and DSM-5 definitions of alcohol and cannabis use disorders: a population survey

The proposed criteria for alcohol and cannabis use disorders in the 11th edition of ICD (ICD-11) will be presented to the World Health Assembly in 2017, but the beta-phase descriptions have been released. We compared them with those in the tenth edition (ICD-10) and the American Psychiatric Associations DSM fourth edition (DSM-IV) and fifth edition (DSM-5), in a nationally representative sample of adult Australians. Disorders were assessed with the WHO World Mental Health Composite International Diagnostic Interview. The proportions classified as being dependent on alcohol and cannabis were similar with ICD-10, ICD-11, and DSM-IV, whereas for DSM-5, the proportion of lifetime users meeting the criteria for moderate to severe use (most comparable to dependence in the other systems) was far higher. We assessed whether criteria for alcohol and cannabis use described unidimensional syndromes for each, and all definitions seemed to do so. Classification of alcohol and cannabis use disorders, although simplified in ICD-11, was in almost perfect agreement with the classifications of ICD-10 and DSM-IV. With DSM-5, use disorder seemed to capture a different aspect of problematic use and selected a different group of individuals from the other systems. How the newest definitions will become used remains to be seen. The choice of classification might depend on the clinical population of interest.

Substance dependence among those without symptoms of substance abuse in the World Mental Health Survey.

The World Health Organization (WHO) World Mental Health (WMH) Survey Initiative uses the Composite International Diagnostic Interview (CIDI). The first 13 surveys only assessed substance dependence among respondents with a history of substance abuse; later surveys also assessed substance dependence without symptoms of abuse. We compared results across the two sets of surveys to assess implications of the revised logic and develop an imputation model for missing values of lifetime dependence in the earlier surveys. Lifetime dependence without symptoms of abuse was low in the second set of surveys (0.3% alcohol, 0.2% drugs). Regression‐based imputation models were built in random half‐samples of the new surveys and validated in the other half. There were minimal differences for imputed and actual reported cases in the validation dataset for age, gender and quantity; more mental disorders and days out of role were found in the imputed cases. Concordance between imputed and observed dependence cases in the full sample was high for alcohol [sensitivity 88.0%, specificity 99.8%, total classification accuracy (TCA) 99.5%, area under the curve (AUC) 0.94] and drug dependence (sensitivity 100.0%, specificity 99.8%, TCA 99.8%, AUC 1.00). This provides cross‐national evidence of the small degree to which lifetime dependence occurs without symptoms of abuse. Imputation of substance dependence in the earlier WMH surveys improved estimates of dependence.

Implantable cardioverter-defibrillator therapy in Australia, 2002-2015

Objectives: To quantify the number of implantable cardioverter–defibrillator (ICD) procedures in Australia by year, patient age and sex, and to estimate age group‐specific population rates and the associated costs.

The impact of cohort substance use upon likelihood of transitioning through stages of alcohol and cannabis use and use disorder: Findings from the Australian National Survey on Mental Health and Wellbeing

INTRODUCTION AND AIMS We used population-level Australian data to estimate prevalence, age of onset and speed of transitions across stages of alcohol and cannabis use, abuse and dependence, and remission from disorder, and consider the potential impacts that an individuals age cohorts level of substance use predicted transitions into and out of substance use. DESIGN AND METHODS Data on use, DSM-IV use disorders, and remission from these disorders were collected from participants (n = 8463) in the 2007 Australian National Survey of Mental Health and Wellbeing using the Composite International Diagnostic Interview. RESULTS Lifetime prevalence (95% confidence interval) of alcohol use, regular use, abuse and dependence were 94.1% (93.3-94.8%), 64.5% (62.9-66.2%), 18.7% (17.4-19.9%) and 4.0% (3.4-4.6%). Lifetime prevalence of cannabis use, abuse and dependence were 19.8% (18.6-20.9%), 4.4% (3.8-5.0%) and 1.9% (1.5-2.4%). Among those with the disorder, rates of remission from cannabis abuse, alcohol abuse, cannabis dependence and alcohol dependence were 90.5% (87.4-93.6%), 86.2% (83.8-88.7%), 79.6% (71.1-88.1%) and 53.8% (46.6-61.0%). Increases in the estimated proportion of people in the respondents age cohort who used alcohol/cannabis as of a given age were significantly associated with most transitions from use through to remission beginning at the same age. DISCUSSION AND CONCLUSIONS Clear associations were documented between cohort-level prevalence of substance use and personal risk of subsequent transitions of individuals in the cohort from use to greater substance involvement. This relationship remained significant over and above associations involving the individuals age of initiation. These findings have important implications for our understanding of the causal pathways into and out of problematic substance use.