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Should tolerance and withdrawal be required for substance dependence disorders?
K M Carroll1, B J Rounsaville, K J Bryant
1Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519.
Drug and Alcohol Dependence
|August 1, 1994
Summary
Empirical evaluations of tolerance and withdrawal in substance dependence are infrequent. This study found that these criteria had little effect on dependence rates and were not superior to other dependence indicators.
Area of Science:
- Psychiatry
- Addiction Medicine
- Clinical Psychology
Background:
- Tolerance and withdrawal are historically significant in substance abuse diagnosis.
- Empirical research comparing these physical dependence criteria with non-physical ones is limited.
Purpose of the Study:
- To evaluate the diagnostic utility of tolerance and withdrawal criteria for substance use disorders.
- To assess the validity of these criteria against other dependence indicators.
Main Methods:
- Analysis of data from 521 subjects participating in a survey for proposed DSM-IV substance use disorder options.
- Comparison of dependence rates and validity indicators between criteria sets.
Main Results:
- Requiring tolerance or withdrawal had minimal impact on overall dependence rates across drug classes.
- Most subjects meeting dependence criteria also reported tolerance.
- Tolerance and withdrawal did not outperform other dependence criteria on measures of concurrent and predictive validity, including severity.
Conclusions:
- Tolerance and withdrawal criteria may not be as essential for diagnosing substance use disorders as historically assumed.
- Non-physical dependence criteria may offer comparable or superior validity in assessing substance use disorders.