Diagnostic Criteria for MDMA abuse and dependence

A recent paper on the test / re-test reliability of diagnostic criteria for MDMA abuse and dependence is fascinating. Foremost because the nature of substance abuse is always a fun topic for discussion when you are dealing with a compound which the users argue so strenuously is perfectly benign. Even more so because the advocacy position tends to put a finer point on the argument about just how to draw lines between ordered and disordered behavior within what is very likely a continuous distribution. The paper also shows some of the limitations of trying to fit drugs which have very distinct subjective experience profiles, use patterns and even dependence modes/risks into a single (albeit reasonably flexible) diagnostic strategy.
In their paper Test-re-test reliability of DSM-IV adopted criteria for 3,4-methylenedioxymethamphetamine (MDMA) abuse and dependence: a cross-national study, Cottler and colleagues are primarily focused on whether diagnostic criteria for MDMA abuse and dependence (there are distinct diagnoses for some substances of abuse within the Diagnostic and Statistical Manual of Mental Disorders, but not for MDMA which falls under the general abuse criteria) are reliable. As you might imagine, it is a pretty important part of medical diagnosis that a given clinical test gives the same answer when repeated for the same individual in close temporal proximity. It is no great leap of genius to see that reliability is even more important when the diagnostic instrument consists of asking people about their affect and behaviors. Particularly when the behaviors are illegal and socially stigmatized.