Comparisons of diagnostic concordance between DSM-IV and DSM-5 have yielded variable findings.Agrawal et al. (2011) reported an 11.3% greater prevalence of alcohol use disorders (AUDs) using DSM-5 criteria compared with DSM-IV criteria. In contrast, Mewton et al. (2010) reported that the application of DSM-5 criteria resulted in a 61.7% greater prevalence than DSM-IV criteria. A major reason for these discrepant findings appears to be that “hazardous use” was operationalized very differently in the two studies (Agrawal et al., 2011). Diagnostic discordance, particularly that attributable to “diagnostic switching,” in which an individual receives a diagnosis in one but not the other system, can yield substantial changes in prevalence and thereby affect treatment decisions (Agrawal et al., 2010). An evaluation of current cocaine use disorders among more than 6,000 state prison inmates showed a 13% lower prevalence for DSM-5 compared with DSM-IV diagnoses (Proctor et al., 2012). Similarly, the application of DSM-5 criteria resulted in a 2% lower prevalence of current opioid use disorders in a sample of chronic pain patients (Boscarino et al., 2011).
