The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a manual detailing diagnostic criteria for mental health disorders and substance use disorders (SUDs). In May 2013, the DSM-5 was released, the first major revision since the publication of DSM-IV in 1994. The DSM-5 revision contains changes in structure, content, and criteria, based upon research developments over the past 20 years, including the addition and removal of several disorders as well as changes to criteria for specific disorders.

The National Survey on Drug Use and Health (NSDUH) and the Mental Health Surveillance Study (MHSS) clinical interview assess SUDs and mental health disorders based on DSM-IV criteria. DSM-5–based disorder prevalence estimates may differ from those obtained using DSM-IV criteria, causing NSDUH and MHSS clinical study estimates to diverge from DSM-5 estimates. Evaluation of criteria changes for SUD indicates that current DSM-IV–based NSDUH estimates may underestimate DSM-5 diagnosed SUDs, depending on the substance being examined. The prevalence of single-item endorsement for SUDs, indicates that alcohol, hallucinogens, and prescription pain relievers have the highest risk for misclassification of SUD resulting from unassessed criteria (i.e., substance craving).

Research on the expected difference between DSM-IV– and DSM-5–based estimates is limited. Available data suggest DSM-5–based prevalence estimates among adults may be marginally higher than DSM-IV–based prevalence estimates. Therefore, the current MHSS may provide an underestimate of DSM-5 disorders, which could lead to a higher rate of false negatives in the any mental illness (AMI) and serious mental illness (SMI) algorithms used in NSDUH. Several additional disorders may merit inclusion in future MHSSs, which may improve the sensitivity and specificity of the AMI/SMI algorithm in NSDUH. However, the addition of disorders to the MHSS would increase the respondent burden and lengthen the interview. Priority should be given to disorders with a high prevalence and/or a high clinical relevance (i.e., SMI). Also, disorders that are likely to affect the overall prevalence of AMI or SMI should be given consideration. If a particular disorder is highly comorbid with another, already assessed disorder, then adding the new disorder would not have a strong effect on the overall prevalence of AMI/SMI. Attention deficit hyperactivity disorder, binge eating disorder, and conduct disorder may offer the best tradeoff of information gained versus added respondent burden.

One additional change to the DSM may merit further consideration. The DSM-5 has eliminated the global assessment of functioning (GAF) score, which was an important component for determining mental illness severity in the AMI/SMI algorithm. It has been suggested that the World Health Organization Disability Assessment Schedule (WHODAS) be used as a replacement for the GAF in determining severity of mental illness. If the WHODAS were used to identify impairment instead of the GAF, then the WHODAS data collected in the MHSS would be used to identify the cases with a clinical diagnosis of SMI, while the WHODAS data collected in the main NSDUH interview would be used in the model that predicts SMI.