Screening for DSM-5 cannabis dependence using the Cannabis Use Identification Test–Revised
R. Bruno1, S. Marshall1, S. Adamson2. 1School of Psychology, University of Tasmania, Australia; 2National Addiction Centre, University of Otago, New Zealand
Background: Cannabis use is prevalent; however, it receives limited attention in primary health settings. The Cannabis Use Disorders Identification Test–Revised (CUDIT-R) is a brief, eight-item screening measure. The scale has good psychometric properties in clinical populations, but its applicability in community samples and in relation to DSM-5 cannabis use disorder has not been examined.
Methods: In all, 310 non-treatment-seeking cannabis consumers in the community (57% male) completed an Internet survey comprising the CUDIT-R and structured assessments of DSM-IV and DSM-5 dependence.
Results: Almost half the sample were consuming cannabis weekly or more frequently (46%), and the mean CUDIT-R score was 9.6 (range 1–28). Using DSM-IV criteria, 13% met abuse criteria and 26% dependence. Applying DSM-5, 46% met criteria for cannabis use disorder (22%, 10%, and 14% for mild, moderate, and severe, respectively). Receiver operating characteristic analyses demonstrated high sensitivity and specificity of CUDIT-R scores of ≥13 for identification of DSM-IV dependence and DSM-5 moderate and severe cannabis use disorder. CUDIT-R scores were strongly correlated with both quantity and frequency of cannabis use, and those categorized as likely dependent (≥13) demonstrated significantly greater psychological distress (Kessler-10), and poorer physical and mental health functioning (SF-12).
Conclusion: Clinical cutoff values on the CUDIT-R for DSM-IV dependence in this community sample are consistent with those identified in treatment-seeking cannabis consumers, and also remain valid for identification of likely cases of DSM-5 cannabis use disorder. The CUDIT-R is readily applicable as a screening tool to identify problematic cannabis use and provides an excellent basis for brief interventions.