If the diagnostic threshold of 2/11 symptoms is too lenient, what should the new threshold be? If all 11 draft criteria will be used in DSM-5, it is reasonable to consider diagnostic cut-points ranging from three to six symptoms. A 3/11 threshold would suffer from many of the limitations discussed herein, while a 6/11 threshold would probably prove to be too strict. However, we do not believe that the proposed 11-item criterion set is optimal. A preferable way to increase the diagnostic threshold for SUDs is to remove especially mild, poorly performing and theoretically compromised symptoms from the criterion set. Research is needed to contrast diagnostic algorithms with various permutations of criteria and thresholds, using relevant external criteria.
