Other limitations in the present study include the fact that, although the SSADDA measured craving, it did not assess whether craving clustered within the same 12-month period as other criteria. Similarly, clustering of DSM-IV abuse criteria could not be incorporated in the DSM-5 diagnoses. To ensure that this did not inflate our estimates of the prevalence of DSM-5 SUDs, we assessed the impact of clustering of the dependence symptoms on the rate of DSM-IV diagnoses. The results showed a very modest effect of the clustering requirement, suggesting that the lack of information on clustering for DSM-5 is unlikely to have confounded the results reported here. Because only lifetime SUD diagnoses were measured with the SSADDA, we were unable to examine the impact of the changes in DSM-5 on current SUDs. We also lacked a “gold standard” against which to evaluate the modest differences in the prevalence of SUD diagnoses between DSM-IV and DSM-5. The identification of valid biomarkers for SUD disorders would potentially enhance both the reliability and validity of SUD diagnoses, although to date, all DSM diagnoses have depended
