Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 11
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Castaldelli-Maia, João Mauricio Andrade, Laura H. Keyes, Katherine M. Cerdá, Magdalena Pilowsky, Daniel J. and Martins, Silvia S. 2016. Exploring the latent trait of opioid use disorder criteria among frequent nonmedical prescription opioid users. Journal of Psychiatric Research, Vol. 80, p. 79.

    Fernández-Calderón, David Fernández, Fermín Ruiz-Curado, Sofía Verdejo-García, Antonio and Lozano, Óscar M. 2015. Profiles of substance use disorders in patients of therapeutic communities: Link to social, medical and psychiatric characteristics. Drug and Alcohol Dependence, Vol. 149, p. 31.

    Kwon, Jung Hye Hui, David and Bruera, Eduardo 2015. A Pilot Study To Define Chemical Coping in Cancer Patients Using the Delphi Method. Journal of Palliative Medicine, Vol. 18, Issue. 8, p. 703.

    Shmulewitz, Dvora Greene, Emily R. and Hasin, Deborah 2015. Commonalities and Differences Across Substance Use Disorders: Phenomenological and Epidemiological Aspects. Alcoholism: Clinical and Experimental Research, Vol. 39, Issue. 10, p. 1878.

    Brabant, Michel Brissette, Suzanne Lauzon, Pierre Marsan, Stéphanie Ouellet-Plamondon, Clairélaine and Pelletier, Marie-Chantal 2014. Les troubles liés à l’utilisation des opioïdes prescrits médicalement. Santé mentale au Québec, Vol. 39, Issue. 2, p. 117.

    Jackson, K. M. Bucholz, K. K. Wood, P. K. Steinley, D. Grant, J. D. and Sher, K. J. 2014. Towards the characterization and validation of alcohol use disorder subtypes: integrating consumption and symptom data. Psychological Medicine, Vol. 44, Issue. 01, p. 143.

    Sánchez-García, Sergio García-Peña, Carmen González-Forteza, Catalina Jiménez-Tapia, Alberto Gallo, Joseph J. and Wagner, Fernando A. 2014. Depressive symptoms among adolescents and older adults in Mexico City. Social Psychiatry and Psychiatric Epidemiology, Vol. 49, Issue. 6, p. 953.

    García-Velázquez, R. Martín-Gandullo, S. Vélez-Moreno, A. and Lozano, O.M. 2012. Aproximaciones metodológicas en la investigación nosológica del trastorno por uso de sustancias. Trastornos Adictivos, Vol. 14, Issue. 2, p. 37.

    Reedy, Amanda R. and Kobayashi, Rie 2012. Substance Use and Mental Health Disorders: Why Do Some People Suffer From Both?. Social Work in Mental Health, Vol. 10, Issue. 6, p. 496.

    Schepis, Ty S. and McCabe, Sean Esteban 2012. Exploring age of onset as a causal link between major depression and nonmedical use of prescription medications. Drug and Alcohol Dependence, Vol. 120, Issue. 1-3, p. 99.

    McBride, O. Teesson, M. Baillie, A. and Slade, T. 2011. Assessing the Dimensionality of Lifetime DSM-IV Alcohol Use Disorders and a Quantity-Frequency Alcohol Use Criterion in the Australian Population: a Factor Mixture Modelling Approach. Alcohol and Alcoholism, Vol. 46, Issue. 3, p. 333.


Abuse and dependence on prescription opioids in adults: a mixture categorical and dimensional approach to diagnostic classification

  • L.-T. Wu (a1), G. E. Woody (a2), C. Yang (a3), J.-J. Pan (a4) and D. G. Blazer (a1)
  • DOI:
  • Published online: 12 May 2010

For the emerging DSM-V, it has been recommended that dimensional and categorical methods be used simultaneously in diagnostic classification; however, little is known about this combined approach for abuse and dependence.


Using data (n=37 708) from the 2007 National Survey on Drug Use and Health (NSDUH), DSM-IV criteria for prescription opioid abuse and dependence among non-prescribed opioid users (n=3037) were examined using factor analysis (FA), latent class analysis (LCA, categorical), item response theory (IRT, dimensional), and factor mixture (hybrid) approaches.


A two-class factor mixture model (FMM) combining features of categorical latent classes and dimensional IRT estimates empirically fitted more parsimoniously to abuse and dependence criteria data than models from FA, LCA and IRT procedures respectively. This mixture model included a severely affected group (7%) with a comparatively moderate to high probability (0.32−0.88) of endorsing all abuse and dependence criteria items, and a less severely affected group (93%) with a low probability (0.003−0.16) of endorsing all criteria. The two empirically defined groups differed significantly in the pattern of non-prescribed opioid use, co-morbid major depression, and substance abuse treatment use.


A factor mixture model integrating categorical and dimensional features of classification fits better to DSM-IV criteria for prescription opioid abuse and dependence in adults than a categorical or dimensional approach. Research is needed to examine the utility of this mixture classification for substance use disorders and treatment response.

Corresponding author
*Address for correspondence: L.-T. Wu, Sc.D., Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC27710, USA. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

C Beseler , KC Jacobson , WS Kremen , MJ Lyons , SJ Glatt , SV Faraone , NA Gillespie , MT Tsuang (2006). Is there heterogeneity among syndromes of substance use disorder for illicit drugs? Addictive Behaviors 31, 929947.

KK Bucholz , AC Heath , T Reich , VM Hesselbrock , JR Kramer , Jr. JI Nurnberger , MA Schuckit (1996). Can we subtype alcoholism? A latent class analysis of data from relatives of alcoholics in a multicenter family study of alcoholism. Alcoholism: Clinical and Experimental Research 20, 14621471.

A Feingold , B Rounsaville (1995). Construct validity of the dependence syndrome as measured by DSM-IV for different psychoactive substances. Addiction 90, 16611669.

NA Gillespie , MC Neale , CA Prescott , SH Aggen , KS Kendler (2007). Factor and item-response analysis DSM-IV criteria for abuse of and dependence on cannabis, cocaine, hallucinogens, sedatives, stimulants and opioids. Addiction 102, 920930.

JE Helzer , KK Bucholz , M Gossop (2007). A dimensional option for the diagnosis of substance dependence in DSM-V. International Journal of Methods in Psychiatric Research 16 (Suppl. 1), S24S33.

L Hu , PM Bentler (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal 6, 155.

TR Kosten , BJ Rounsaville , TF Babor , RL Spitzer , JB Williams (1987). Substance-use disorders in DSM-III-R. Evidence for the dependence syndrome across different psychoactive substances. British Journal of Psychiatry 151, 834843.

PH Kuo , SH Aggen , CA Prescott , KS Kendler , MC Neale (2008). Using a factor mixture modeling approach in alcohol dependence in a general population sample. Drug and Alcohol Dependence 98, 105114.

DJ Kupfer , DA Regier , EA Kuhl (2008). On the road to DSM-V and ICD-11. European Archives of Psychiatry and Clinical Neuroscience 258 (Suppl. 5), 26.

JW Langenbucher , E Labouvie , CS Martin , PM Sanjuan , L Bavly , L Kirisci , T Chung (2004). An application of item response theory analysis to alcohol, cannabis, and cocaine criteria in DSM-IV. Journal of Abnormal Psychology 113, 7280.

Y Lo , NR Mendell , DB Rubin (2001). Testing the number of components in a normal mixture. Biometrika 88, 778.

J Morgenstern , J Langenbucher , EW Labouvie (1994). The generalizability of the dependence syndrome across substances: an examination of some properties of the proposed DSM-IV dependence criteria. Addiction 89, 11051113.

B Muthén (2006). Should substance use disorders be considered as categorical or dimensional? Addiction 101 (Suppl. 1), 6–16.

B Muthén , T Asparouhov (2006). Item response mixture modeling: application to tobacco dependence criteria. Addictive Behaviors 31, 10501066.

CB Nelson , J Rehm , TB Ustün , B Grant , S Chatterji (1999). Factor structures for DSM-IV substance disorder criteria endorsed by alcohol, cannabis, cocaine and opioid users: results from the WHO reliability and validity study. Addiction 94, 843855.

KL Nylund , T Asparouhov , B Muthén (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling. A Monte Carlo simulation study. Structural Equation Modeling: A Multidisciplinary Journal 14, 535569.

H Proudfoot , AJ Baillie , M Teesson (2006). The structure of alcohol dependence in the community. Drug and Alcohol Dependence 81, 2126.

AF Schatzberg (2010). Why is DSM-5 being delayed? Psychiatric News 45, 3.

M Teesson , M Lynskey , B Manor , A Baillie (2002). The structure of DSM-IV cannabis use disorders in the community. Drug and Alcohol Dependence 68, 255262.

CF Turner , L Ku , SM Rogers , LD Lindberg , JH Pleck , FL Sonenstein (1998). Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. Science 280, 867873.

LT Wu , DG Blazer , AA Patkar , ML Stitzer , PG Wakim , RK Brooner (2009 a). Heterogeneity of stimulant dependence: a National Drug Abuse Treatment Clinical Trials Network study. American Journal on Addictions 18, 206218.

LT Wu , JJ Pan , DG Blazer , B Tai , RK Brooner , ML Stitzer , AA Patkar , JD Blaine (2009 b). The construct and measurement equivalence of cocaine and opioid dependences: a National Drug Abuse Treatment Clinical Trials Network (CTN) study. Drug and Alcohol Dependence 103, 114123.

LT Wu , DJ Pilowsky , AA Patkar (2008 a). Non-prescribed use of pain relievers among adolescents in the United States. Drug and Alcohol Dependence 94, 111.

LT Wu , CL Ringwalt , P Mannelli , AA Patkar (2008 b). Prescription pain reliever abuse and dependence among adolescents: a nationally representative study. Journal of the American Academy of Child and Adolescent Psychiatry 47, 10201029.

LT Wu , CL Ringwalt , C Yang , BB Reeve , JJ Pan , DG Blazer (2009 c). Construct and differential item functioning in the assessment of prescription opioid use disorders among American adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 48, 563572.

J Zacny , G Bigelow , P Compton , K Foley , M Iguchi , C Sannerud (2003). College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement. Drug and Alcohol Dependence 69, 215232.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *