The 2/11 algorithm allows a remarkable degree of heterogeneity for something described as a mental disorder, even among those with a similar number of symptoms. Although the polythetic nature of substance problems has long been recognized, the degree of variability in the symptom profile that the proposed algorithm allows makes it hard to recognize any sort of prototypic syndrome whatsoever. Among 1486 persons in NESARC with exactly two past-year DSM-5 symptoms, we observed 41 of the 55 two-symptom configurations that are possible with 11 items. No configuration characterized more than a fraction of this group. Among this two-symptom group, the most frequently endorsed individual criteria were larger/longer (55.30%), quit/cut down (39.10%), hazardous use (36.77%) and tolerance (24.81 %). The 15 most common two-symptom configurations in this group (accounting for 88.8% of the total) contained at least one of these four criteria. Yet tolerance is mild and can present without problems, hazardous use can reflect heedless behavior rather than pathology, and larger/longer and quit/ cut down are often misunderstood and over-endorsed.
