# DSM-5 Criteria for Alcohol and Cannabis Use Disorders: Are Older Adults Less Likely to Endorse Certain Criteria?

## TL;DR

This study finds that older adults are less likely to show certain symptoms of alcohol and cannabis use disorders compared to younger people.

## Contribution

The study identifies age-related differences in the endorsement of DSM-5 criteria for AUD and CUD in older adults.

## Key findings

- Older adults had lower odds of endorsing seven out of eleven AUD criteria, including social impairments and hazardous use.
- For CUD, older adults were less likely to report hazardous use and withdrawal symptoms.
- The findings suggest that clinicians should consider age-specific symptom expression for accurate diagnosis.

## Abstract

With increasing substance misuse among older adults, we examined the question of whether older adults may be less likely to endorse certain DSM-5 criteria for alcohol and cannabis use disorders (AUD and CUD). We used the 2021–2023 National Surveys on Drug Use and Health (N = 17,494 for AUD and N = 12,264 for CUD) and descriptive statistics to compare the 65+ and under 65 age groups in their endorsements of 11 DSM-5 criteria. A multivariable logistic regression model was fitted for each criterion as the dependent variable with the age group as the independent variable and other characteristics as covariates. For AUD, the 65+ age group was associated with lower odds of endorsing seven out of eleven DSM-5 criteria, including social impairments (e.g., failure to fulfill role obligations (aOR = 0.30, 95% CI = 0.16–0.56); social problems (aOR = 0.46, 95% CI = 0.30–0.71); given-up activities (aOR = 0.66, 95% CI = 0.47–0.94); hazardous use (aOR = 0.53, 95% Yes CI = 0.34–0.81); and physical/psychological problems (aOR = 0.51, 95% CI = 0.37–0.70). For CUD, the 65+ age group was less likely than the under 65 age group to endorse hazardous use (aOR = 0.04, 95% CI = 0.01–0.17) and withdrawal (aOR = 0.39, 95% CI = 0.20–0.73 for criterion A and aOR = 0.16, 95% CI = 0.05–0.48 for criterion B). Clinicians should be aware that older adults might not express the full range of symptoms in the same way as the younger age groups. A more nuanced understanding of older adults’ social context may be needed for accurate diagnosis.