Endorsement and Concordance of Icd-10 versus Dsm-iv Criteria for Substance Dependence : Indian Perspective

Substance use disorders have undergone major changes in both the international (ICD-10) and American (DSM-IV) nosological systems, thus necessitating a study of cross-system agreement between ICD-10 and DSM-IV substance dependence, especially from a developing country setting. Further, endorsement rates for various substance dependence criteria in the two systems need to be studied from a similar perspective. Hence, 221 consecutive patients with 279 diagnostic categories of substance dependence attending a de-addiction centre in Northern India were studied with regard to endorsement of the various ICD-10 and DSM-IV criteria as well as for cross-system agreement for severity of dependence. High endorsement rates were seen for most criteria in both the systems, except for those related to 'persistence despite harm' and 'salience (neglect of various activities, plus excessive time spent to procure the substance)'. There were some significant differences, however, between endorsement rates across different substance categories in both the systems. Cross-system agreement on severity of substance dependence ranged from fair to good for all categories combined, and was good to excellent for the opioid category. The category of 'others' (nicotine, cannabis and sedative-hypnotics) showed poor cross-system agreement Overall, the results lend support to the basic theoretical construct behind both ICD-10 and DSM-IV substance dependence syndrome from a developing country perspective.