Do DSM-5 substance use disorder criteria differ by user care settings? An item response theory analysis approach

To examine differences in the psychometric characteristics of diagnostic criteria for Substance Use Disorders (SUD) between substance users harm reduction settings (HR) and seeking treatment (Tx). Differential Item Test Functioning (DIF & DTF) analysis were performed to difficulty endorsement discrimination 11 test if set as a whole (the “test”) functioned differently by care (Tx vs. HR) alcohol, cocaine, cannabis, opiates tobacco. uniform nonuniform DIF, multiple indicator cause (MIMIC) structural equation models used. Regardless substance, DSM-5 “craving”, “large amount”, “time spent”, “tolerance” “activities given up” had similar functioning settings. Little evidence DIF was found other criteria. The did not function cocaine At same trait severity, compared HR, Tx subgroup greater number endorsed cannabis smaller opioids. unidimensionality applicability all diagnosis confirmed this large sample problematic users. While majority related loss control use, well both settings, consequences use several differential functioning.