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An evaluation of DSM-III-R and ICD-10 benzodiazepine dependence criteria using Rasch modelling
C C Kan1, M H Breteler, A H van der Ven
1Department of Psychiatry, University of Nijmegen Research Group on Addictive Behaviours (UNRAB), University of Nijmegen, University Hospital, The Netherlands.
Aims:
To evaluate the homogeneity of the elements of the Substance Dependence Syndrome (SDS) as applied to benzodiazepines (BZDs) by Rasch modelling.
Measurements:
The Rasch scaling model was applied to data obtained by administering the SCAN (Schedules for Clinical Assessments in Neuropsychiatry) substance dependence sections. Subsequently, Rasch-homogeneous sets of DSM-III-R and ICD-10 BZD dependence criteria were assessed for subject and item discriminability. To support their construct validity a theoretical rationale was formulated based on the Rasch scale values.
Participants:
A heterogeneous sample of 599 outpatient BZD users.
Findings:
Only particular subsets of the DSM-III-R and ICD-10 BZD dependence criteria met the requirements for Rasch-homogeneity, which appears to be due to medical aspects of BZD use. The subject and item discriminability results were sufficiently good.
Conclusions:
The DSM-III-R and ICD-10 BZD dependence constructs may need to be redefined. The use of a BZD dependence severity model based on a Rasch-homogeneous scale appears to have greater clinical value than a dichotomous diagnostic model based on an arbitrary cut-off point. We recommend Rasch modelling to investigate the homogeneity of the elements of the SDS across other psychoactive substances.