In DSM-IV, substance-related legal problems pertain to legal consequences of intoxicated behavior (e.g., arrests for disorderly conduct, assault and battery; driving under the influence) rather than drug possession per se, so changes over time in drug possession laws and their enforcement are unlikely to have affected the utilityof the legal problems criterion. Substance-related legal problems were included in the earliest substance disorder diagnostic criteria because they occurred much more frequently among alcoholic than non-alcoholic prison inmates, the original study population for developing the criteria (Guze et al., 1962). Present clinical concerns about removing legal problems in DSM-5 include that this criterion may be more important for diagnosis in patients than in the general population. We did not find this to be the case. The legal problems criterion was rarely endorsed, was never the only criterion for any patient and in no case would have led to an additional DSM-5 SUD diagnosis among patients who had only one other criterion. In addition, while we did not have to drop legal problems to achieve unidimensionality of the SUD criteria as some studies
