Assessing measurement bias in substance use disorder criteria associated with childhood adversity and genetic liability.

Abstract

Objective: The diagnosis and severity of substance use disorders (SUDs) are classified by the number of criteria endorsed. However, environmental and genetic factors may influence criterion endorsement. To evaluate this, we tested for differential item functioning of SUDs criteria by adverse childhood events (ACEs) and SUD polygenic scores.

Method: In 10,275 Yale-Penn participants (M_age = 40.59 years, 56.2% male, 47.21% of African-like genetic ancestry, 52.79% of European-like genetic ancestry), we used item response theory models to estimate difficulty and discrimination parameters for each criterion for alcohol, cannabis, and opioid use disorders. We then tested whether these properties varied based on scores on a latent ACEs factor and ancestry-specific polygenic scores using moderated nonlinear factor analyses.

Results: There was variability in the difficulty and discrimination of SUD criteria. Many criteria discriminated less effectively among individuals with higher ACEs factor scores. Continued substance use despite physical/psychological problems (β = .08, SE = 0.01, p < .0001) and withdrawal (β = .07, SE = 0.02, p = .001) were more difficult to endorse for individuals with high ACEs scores than those with lower ACEs scores. No differential item functioning was identified by polygenic scores.

Conclusions: Findings highlight the impact of ACEs on SUD assessment. Considering the relative weighting of criteria or developing screening procedures that consider subgroup-specific differences in symptom functioning may help address these biases. (PsycInfo Database Record (c) 2026 APA, all rights reserved).