Reasons to remove legal problems from the criteria set included very low prevalence in adult samples (31, 35, 37, 38, 41, 57) and in many (58, 61, 69) although not all (58, 60, 68) adolescent samples, low discrimination (28, 36, 57, 64, 66, 69, 75), poor fit with other substance use disorder criteria (28, 32, 35, 47, 51, 76), and little added information in item response theory analyses (28, 37, 41, 44). Some clinicians were concerned that dropping legal problems would leave certain patients undiagnosed, an issue specifically addressed among heavy alcohol, cannabis, cocaine, and heroin users in methadone and dual-diagnosis psychiatric settings (57). None of these patients reported substance-related legal problems as their only criterion or “lost” a DSM-5 substance use disorder diagnosis without this criterion. Thus, legal problems are not a useful substance use disorder criterion, although such problems may be an important treatment focus in some settings.
