Examination of the DSM-5 level 2 substance use measure using Rasch modeling with United States parents

The DSM-5 Substance Use Disorder (SUD) Adult Level 2 measure is one of the new Cross Cutting (CC) measures recommended by the American Psychiatric Association to evaluate symptoms across multiple disorders with two levels. While widely used, very little is published on the validity and reliability of the CC measures and none to date on the SUD level 2 measure, which examines the use of substances in the last 7 days.

Employing a scale development and validation framework, this study examined reliability and validity evidence for the SUD level 2 CC measure with a sample of 1049 U.S.-based parents. Factor structure, reliability, response scale, and targeting were examined via three Rasch models.

This study found that this measure can be considered a unidimensional construct of substance use. While the item on marijuana use can be used within this construct, it does stand out with much more frequent use. Dimensionality and scale use patterns were the same when comparing a sample of parents in the United States that included those who use substances and those who do not to a sample of just those who used substances.

The 5-point scale indicating frequency of use was problematic and we recommend consideration of a 3-point scale instead, where 0 = never, 1 = sometimes, and 2 = frequently. Evidence of construct validity and reliability supports the use of this scale with adults in the United States.