The problems pertaining to the DSM-IV hierarchy of dependence over abuse also included “diagnostic orphans” (21–24), the case of two dependence criteria and no abuse criteria, potentially a more serious condition than abuse but ineligible for a diagnosis. Also, when the abuse criteria were analyzed without regard to dependence, their test-retest reliability improved considerably (5), suggesting that the hierarchy, not the criteria, led to their poor reliability. Finally, factor analyses of dependence and abuse criteria (ignoring the DSM-IV hierarchy) showed that the criteria formed one factor (25, 26) or two highly correlated factors (27–34), suggesting that the criteria should be combined to represent a single disorder.
