CARS-5: What to Expect

The Division on Addiction and Foundation for Advancing Alcohol Responsibility are proud to announce the upcoming release of the latest version of CARS, CARS-5. As a reminder, CARS-5 is not backward compatible with prior versions of CARS. When you download CARS-5, all data from previous CARS sessions will be overwritten. If you are using another earlier version of CARS, you will need to generate all of the reports you want to save before upgrading to CARS-5. For information on how to save your data before updating to CARS-5, please refer to our Quick Guides and CARS User Manual that contain information on this process.

In this post, we detail some of the changes you’ll see as part of CARS-5.

CARS-5 contains updated screener and module questions to better reflect current diagnostic criteria for mental health disorders. These range from small phrasing changes to full disorder and criteria recategorization. We have also added and expanded modules, provided Spanish versions of the CARS Screener and Self-administered Screener, and improved user and security features. Notably, all modules now assess for lifetime presence of all disorders and more modules have been added to the CARS program. Specific changes for each module are detailed below.

CARS-5 Screener Updates

  • Updated criteria to receive positive screens for the following disorders: 
    • Past Year Positive Screen Criteria Updated: Intermittent Explosive Disorder, Social Anxiety Disorder, Eating Disorder and Attention Deficit Disorder
    • Lifetime Positive Screen Criteria Updated: Intermittent Explosive Disorder, Social Anxiety Disorder and Attention Deficit Disorder 
  • Revised and/or additional questions for the following disorders and domains: 
    • Panic Disorder, Intermittent Explosive Disorder, Depression, Suicidality, Mania, Social Anxiety Disorder, Tobacco Use, Alcohol Use, Drug Use, Obsessive Compulsive Disorder, Attention Deficit Disorder, Driving Under the Influence Behavior and Post Traumatic Stress Disorder
  • Updated criteria for module entry for the following modules: 
    • Intermittent Explosive Disorder, Social Anxiety Disorder, Attention Deficit Disorder and Driving Under the Influence Behavior
  • New Spanish versions of the Screener and Self-Administered Screener

CARS-5 In-Depth Module Updates

Alcohol Use Disorder

  • Diagnostic criteria and counts changed to reflect current criteria for Alcohol Use Disorder, not separate alcohol abuse and dependence criteria.
    • Removed legal problems as a diagnostic criterion
      • Questions in CARS referencing legal problems related to alcohol removed 
    • Added craving as a diagnostic criterion
      • Question related to alcohol craving added to CARS
  • Severity levels added to the disorder: mild, moderate, and severe
    • Levels distinguished in CARS by number of symptoms endorsed
  • Report content modified to better reflect assessment

Attention Deficit Hyperactivity Disorder (ADHD)

  • Diagnostic criteria and counts changed to reflect current criteria for ADHD
    • No longer required that symptom presentation occur before age 7, and only five symptoms, not six, required for adult diagnosis
      • Language in ADHD questions altered to reflect these changes 
  • CARS now reports three ADHD subtypes: combined presentation (inattention and hyperactivity-impulsivity criteria both met), predominantly inattentive presentation, and predominantly hyperactive/impulsive presentation
  • Subclinical diagnosis removed and severity levels added: mild, moderate, and severe
    • Levels distinguished in CARS by number of symptoms endorsed        
  • Lifetime diagnosis section added
  • Report content modified to better reflect assessment  

Depression

  • Diagnostic criteria changed to reflect current criteria for depression-related diagnoses. 
    • Dysthymia now called Persistent Depressive Disorder, which encompasses symptoms previously classified as Dysthymia, as well as chronic major depression
      • Question content and skip logic altered to reflect this change
    • Major Depressive Episode no longer defined separately from Major Depressive Disorder
      • Skip logic altered to reflect this change
    • Bereavement no longer an exclusionary criterion for Major Depressive Disorder
      • Skip logic altered to reflect this change
  • Lifetime diagnosis section added
  • Report content modified to better reflect assessment

Gambling Disorder [NEW]

  • The Gambling Disorder module is introduced in CARS-5.

Generalized Anxiety Disorder

  • Diagnostic criteria changed to reflect current criteria for Generalized Anxiety Disorder
    • Altered list of potentially endorsed worries
  • Deleted questions already covered by the Screener module
  • Lifetime diagnosis section added
  • Report content modified to better reflect assessment

Mania

  • Diagnostic criteria changed to reflect current criteria for Mania, Hypomania, Bipolar I, and Bipolar II Disorders
    • Changes to Bipolar categories
      • Output no longer includes “not otherwise specified category” but has an expanded subclinical category
    • Addition of language related to goal-directed behavior and persistence throughout the day
      • Question content modified to reflect current language related to goal-directed behavior and persistence of symptoms
    • Criterion about distractibility modified to include distractibility as observed by others
      • Question added to assess whether others observed distractibility 
  • Lifetime diagnosis section added
  • Report content modified to better reflect assessment

Obsessive-Compulsive Disorder [NEW]

  • The Obsessive-Compulsive Disorder module is introduced in CARS-5.

Panic Disorder

  • Diagnostic criteria changed to reflect current criteria for Panic Attacks and Panic Disorder
    • Panic disorder symptom list modified
      • Screener module symptoms altered and reworded
    • Timeframe for the onset of a panic disorder changed from 10 minutes to within minutes
      • Question content and assessment skip logic altered accordingly
      • All instances of “ten minutes” have been changed to “minutes” in accordance with changes in DSM-5 wording
  • Lifetime diagnosis section added
  • Report content modified to better reflect assessment

Post-Traumatic Stress Disorder (PTSD)

  • Diagnostic criteria changed to reflect current criteria for PTSD
    • Different language used to describe traumatic events
      • Questions reworded to reflect different language
    • Traumatic event no longer needs to be experienced in person; individual can be a witness or learn of the traumatic event happening to family or close friend
    • Questions about whether individual has witnessed stressful or upsetting events firsthand and whether individual has been told about stressful or upsetting experiences by family or friends added
    • Immediate reaction to the event of fear, helplessness, shock, or numbness no longer required
      • Questions about these reactions removed from Screener module 
    • Number of symptoms clusters changed from three to four
      • Assessment skip logic changed accordingly
    • More detailed descriptions of symptoms throughout
      • Questions added/reworded to reflect additional detail
    • Substance and medical exclusion added to criteria
      • Questions added to address substance/medical exclusion
  • Lifetime diagnosis section added
  • Report content modified to better reflect assessment

Social Anxiety Disorder

  • Primary label changed from Social Phobia to Social Anxiety Disorder
    • All question content and output altered accordingly
  • Diagnostic criteria changed to reflect current criteria for Social Anxiety Disorder
    • Criterion about fear being out of proportion to actual threat modified so individual no longer has to recognize that fear is unreasonable
      • Questions and output within the Screener module and Social Anxiety module modified accordingly
  • Lifetime diagnosis section added
  • Report content modified to better reflect assessment

Substance Use Disorder

  • Diagnostic criteria and counts changed to reflect current criteria for Substance Use Disorder, not separate drug abuse and dependence criteria.
    • Removed legal problems as a diagnostic criterion
      • Questions in CARS referencing legal problems related to drug use removed 
    • Added craving added as a diagnostic criterion
      • Question related to substance craving added to CARS
  • Severity levels added to the disorder: mild, moderate, and severe
    • Levels distinguished in CARS by number of symptoms endorsed 
  • Report content modified to better reflect assessment