The proposed changes overcome many problems, while further studies will be needed to address issues for which less data were available. The work group recommendations for DSM-5 revisions included combining abuse and dependence criteria into a single substance use disorder based on consistent findings from over 200,000 study participants, dropping legal problems and adding craving as criteria, adding cannabis and caffeine withdrawal syndromes, aligning tobacco use disorder criteria with other substance use disorders, and moving gambling disorders to the chapter formerly reserved for substance-related disorders. This article presents the major issues and evidence considered by the work group, which included literature reviews and extensive new data analyses. Specific issues included possible addition of withdrawal syndromes for several substances, alignment of nicotine criteria with those for other substances, addition of biomarkers, and inclusion of nonsubstance, behavioral addictions. General concerns included whether to retain the division into two main disorders (dependence and abuse), whether substance use disorder criteria should be added or removed, and whether an appropriate substance use disorder severity indicator could be identified. The DSM-5 Substance-Related Disorders Work Group considered these issues and recommended revisions for DSM-5. Strengths were identified (notably, reliability and validity of dependence), but concerns have also arisen. Since DSM-IV was published in 1994, its approach to substance use disorders has come under scrutiny. the Department of Psychiatry and the Division of Substance Dependence, University of Colorado School of Medicine, Aurora the Department of Psychiatry and Biobehavioral Sciences and the Integrated Substance Abuse Programs, University of California, Los Angeles the Department of Psychiatry and the Behavioral Cardiovascular Prevention Calhoun Cardiology Center, University of Connecticut Health Center, Farmington the Department of Psychiatry, San Diego VA Medical Center, San Diego the Laboratory of Epidemiology and Biometry, National Institute on Alcohol Abuse and Alcoholism, Bethesda Louis the Center for Addiction Research, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock the Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, Md. New York State Psychiatric Institute, New York the Departments of Psychiatry and Epidemiology, Columbia University, New York the Department of Psychiatry, University of Pennsylvania, Philadelphia the Center for Studies of Addiction, Philadelphia the Department of Addiction Psychiatry, Université Bordeaux Ségalen, Bordeaux, France the National Institute of Psychiatry, Federal District, Mexico the Department of Psychiatry, Washington University School of Medicine, St.

Pica disorder length to diagnosis