DSM-V NICOTINE USE DISORDER SYMPTOM PROFILES IN A REPRESENTATIVE SAMPLE OF THE LARGEST METROPOLITAN AREA IN SOUTH AMERICA

Abstract

Aims: Given the development of a new diagnostic classification(DSM-V) for nicotine use disorders(NUD), we aimed to identify continuous and cathegorical fenotipes among indivuduals who had at least 1 cigarette per week during life-time. Most of the conceptual framework for NUD come only from alcohol use disorder(AUD) studies. Data came from São Paulo Megacity Project (SPM) collected between 2005-2007, which is part of World Mental Health Surveys. Methods: Exploratory factorial analysis(EFA) and latent class analysis(LCA) of the DSM-V NUD symptoms - SPM did not include the 3 DSM-IV nicotine abuse questions - were performed using Mplus software taking into account complex survey design features. Then, via weighted logistic regression models, we examined socio-demographic correlates of the DSM-V NUD latent classes. Results: As in DSM-VAUD studies, an one-factor model reached the best fitin EFA, including very high loadings(>60%) of all eight symptoms tested. The best LCA model was a four-class model: 1) a “non-symptomatic class”(31.1%), 2) a “lost control class” (27.3%) - defined by high probabilities of “use in larger amounts” and unable to cut down criteria-, 3) a “craving-tolerance class” (7.9%) and 4) a “high-symptomatic class” (33.6%). Those in the “lost-control class” and “craving tolerance class” were more than 2 times more likely to be 18-34 years-old than those in the non-symptomatic class. Being in the three symptomatic classes was associated with unemployment/other as compared being in the non-symptomatic class. Conclusion: Prevention and specific treatment protocol can be designed based on this data. Varenicline or bupropion, as anti-craving medications, seem to be an interesting treatment option for those in the “craving-tolerance class”. Cognitive-behavioral therapy(plus pharmacological treatment) are adequate for those in “loss-control class”. Unemployed and young adults could be the target of prevention interventions for NUD in Brazil.