Evaluation of DSM-5 Diagnostic Criteria for Betel-Quid Use Disorder Using the Addiction Characteristics Defined by American Society of Addiction Medicine

Background: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), categorizes betel-quid use disorder (BUD) under Other (Or Unknown) Substance Use Disorder, and the diagnostic criteria used are adapted from those of Substance Use Disorder. Because different substances have different characteristics, an improved set of diagnostic criteria is required to better detect BUD. Objective: The objective of this study was to examine the different measures of accuracy for DSM-5 BUD by using the addiction characteristics defined by the American Society of Addiction Medicine (ASAM). Methods: A certified psychiatrist conducted face-to-face diagnostic interviews. Questionnaires were administered to assess betel-quid use history, patterns of use, and dependence features. All betel-quid users were evaluated for BUD by using the DSM-5 criteria and addiction characteristics defined by the ASAM. Results: One of the DSM-5 diagnostic criteria for BUD, namely large amount of time spent on obtaining and using betel quid and recovering from betel-quid use, showed the lowest sensitivity of 0.14, lowest diagnostic accuracy of 0.63, and lowest diagnostic odds ratio of 2.61. Another DSM-5 diagnostic criterion, namely continued betel-quid use despite knowledge of physical or psychological problems, had the lowest specificity of 0.49. The diagnostic threshold of five or more DSM-5 BUD criteria showed a sensitivity of 0.86 and a specificity of 0.97. Conclusions: This study is the first to evaluate the different measures of accuracy for DSM-5 BUD. Given that each addictive substance has unique addictive characteristics, the composition and number of criteria for diagnosing DSM-5 BUD must be reconsidered.