Substance use prevalence, attitudes, and norms vary across groups, settings, and cultures (72–74). Therefore, the work group examined the studies listed in Table 2 in detail for evidence of age, gender, or other cultural bias in the DSM-5 substance use disorder criteria. Such differences are identified in an item response theory framework by testing for differential item functioning (i.e., whether the likelihood of endorsing a criterion differs by group after accounting for mean group differences in the underlying substance use disorders trait). With the exception of legal problems, the criteria did not consistently indicate differential item functioning across studies. Even where differential item functioning was found (e.g., see references 35 and 36), no evidence of differential functioning of the total score (i.e., the underlying substance use disorders trait) was found. Thus, consistent gender or cultural bias was not found, although the extent of the changes proposed for DSM-5 criteria for substance use disorders suggested that there would be value in additional research using different analytic strategies to examine whether gender, age, or ethnic bias exists in the criteria.
