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Substance use disorder: abuse, dependence and dyscontrol

T A Widiger1, G T Smith

  • 1Department of Psychology, University of Kentucky, Lexington 40506-0044.

Addiction (Abingdon, England)
|March 1, 1994
PubMed
Summary

This review examines substance abuse and dependence diagnoses across DSM editions. It proposes a unified "substance dyscontrol disorder" diagnosis, shifting physiological dependence to intoxication/withdrawal categories.

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Area of Science:

  • Psychiatry
  • Addiction Medicine
  • Mental Health Diagnostics

Background:

  • Diagnostic criteria for substance abuse and dependence have evolved significantly through DSM-III, DSM-III-R, and DSM-IV.
  • Understanding the continuum of substance use dyscontrol is crucial for accurate diagnosis.
  • Current diagnostic frameworks may lack definitive criteria for identifying impaired drug use control.

Purpose of the Study:

  • To review and analyze the evolution of diagnostic concepts for substance abuse and dependence in DSM-III, DSM-III-R, and DSM-IV.
  • To incorporate key principles regarding the continuum of dyscontrol and the need for non-moralistic diagnostic criteria.
  • To propose an alternative diagnostic framework for substance use disorders.

Main Methods:

  • Literature review of diagnostic criteria across successive editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

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  • Analysis of core principles related to behavioral dyscontrol and diagnostic objectivity.
  • Development of a conceptual alternative for classifying substance-related disorders.

    • Main Results:

    • The review highlights the lack of infallible criteria for defining substance use dyscontrol.
    • It underscores that substance use dyscontrol exists on a continuum and shares properties with other behavioral dyscontrol.
    • The existing DSM categories for abuse and dependence are critically examined.

    Conclusions:

    • A single diagnosis of "substance dyscontrol disorder" is proposed, integrating current abuse and dependence categories.
    • Physiological substance dependence should be reclassified alongside substance intoxication and withdrawal.
    • This revised framework aims for a more cohesive and objective diagnostic system for substance use disorders.