Diagnosis in the addictions I: Conceptual problems

A crisis of categories exists in the body of knowledge associated with the phenomenon of the addictions. This crisis is characterized by (a) the absence of an accepted paradigm for integrating the knowledge in the field; (b) the consequent paucity of facts; and (c) the lack of integration between research, theory and practice. The problem of diagnosis has been brought into focus by (a) the growth of empirical and theoretical knowledge in the field; (b) the emergence of new patterns of substance use; and (c) changes in socio-cultural values and attitudes. Specifically, the categorical concept of dependence has become confusing and unworkable. A recent attempt at reformulation of diagnostic terminology of the field by the World Health Organization is reviewed and two conceptual schemes for identifying, gathering, and ordering the clinical data necessary to support a multidimensional diagnosis of drug dependence and the specification of drug-related disabilities are examined.