Examination of the diagnostic and statistical manual of mental disorders - 5th edition (DSM-5) cannabis use disorder severity indicators.

Cannon M.; Schermitzler B.; Orrell A.; Macatee R. · Addictive behaviors · 2026

**Background & Methods** This review examined the validity of DSM-5 cannabis use disorder (CUD) severity indicators using confirmatory factor analysis and item response theory in 599 adults with chronic cannabis use (57.6% female) recruited from southeastern universities. Participants completed interviewer-assessed CUD symptom evaluations, and severity groups were compared using multinomial regression on cannabis use behaviors, psychiatric symptoms, and comorbid substance use measures. **Key Findings** - DSM-5 CUD criteria demonstrated good discrimination and difficulty parameters (>1.00) and reflected a unidimensional latent construct with factor loadings ranging from 0.439-0.779, supporting the structural validity of the diagnostic framework. - Moderate/severe CUD showed clinically meaningful differences from mild/no CUD across multiple indices including the Marijuana Problems Scale and Marijuana Motives Measure, with severe CUD associated with greater comorbid general distress and daily nicotine use compared to other severity groups. - Latent severity scores revealed substantial overlap between adjacent severity categories (1.34-31.78% overlap), with limited clinically relevant differences between mild and no CUD presentations, suggesting the moderate and severe classifications better capture meaningful disorder severity than the mild category. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. The study focused on psychiatric comorbidities (distress intolerance, mood and anxiety symptoms) associated with CUD severity rather than direct adverse effects. **Evidence Quality** Strengths include the use of advanced psychometric methods (confirmatory factor analysis, item response theory), adequate sample size (N=599), and objective interviewer-administered assessments. Limitations include the cross-sectional design preventing causal inference, recruitment from university settings potentially restricting generalizability to community or treatment-seeking populations, and the regional focus (southeastern universities) limiting geographic diversity. The study provides moderate evidence supporting DSM-5 CUD severity indicators but does not establish whether these classifications predict treatment outcomes or future cannabis use trajectories. The findings suggest the need for potential recalibration of mild CUD criteria in clinical practice.

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