What is in a Word? Addiction vs. dependence in DSM-V

William Penn University, Filadelfia, Pennsylvania, United States
American Journal of Psychiatry (Impact Factor: 12.3). 06/2006; 163(5):764-5. DOI: 10.1176/appi.ajp.163.5.764
Source: PubMed
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    • "This may be further complicated by the origins of these terms, with some such as “dependency” and “abuse” being associated with a clinical or diagnostic perspective (American Psychiatric Association, 2000), “addiction” carrying a societal broader interpretation and “misuse” being associated with pharmacy studies particularly. This reflects enduring debates about and changes to terminology in the wider addiction literature, including the WHO’s adoption of “dependence” over “addiction” (World Health Organisation, 1964) nearly half a century ago, to recent debates about these terms in the DSM-IV and proposed DSM-V (Dean & Rud, 1984; O’Brien et al., 2006). Underscoring this definitional variation are also fundamental issues about stigma, identify and also agency. "
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    ABSTRACT: The sale of over-the-counter (OTC) medicines from pharmacies can help individuals self-manage symptoms. However, some OTC medicines may be abused, with addiction and harms being increasingly recognised. This review describes the current knowledge and understanding of OTC medicine abuse. Comprehensive search of international empirical and review literature between 1990 and 2011. OTC MEDICINE ABUSE WAS IDENTIFIED IN MANY COUNTRIES AND ALTHOUGH IMPLICATED PRODUCTS VARIED, FIVE KEY GROUPS EMERGED: codeine-based (especially compound analgesic) medicines, cough products (particularly dextromethorphan), sedative antihistamines, decongestants and laxatives. No clear patterns relating to those affected or their experiences were identified and they may represent a hard-to-reach group, which coupled with heterogeneous data, makes estimating the scale of abuse problematic. Associated harms included direct physiological or psychological harm (e.g. opiate addiction), harm from another ingredient (e.g. ibuprofen-related gastric bleeding) and associated social and economic problems. Strategies and interventions included limiting supplies, raising public and professional awareness and using existing services and Internet support groups, although associated evaluations were lacking. Terminological variations were identified. OTC medicine abuse is a recognised problem internationally but is currently incompletely understood. Research is needed to quantify scale of abuse, evaluate interventions and capture individual experiences, to inform policy, regulation and interventions.
    Journal of Substance Use 04/2013; 18(2):82-107. DOI:10.3109/14659891.2011.615002 · 0.48 Impact Factor
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    • "It may also be valuable to consider issues with selfcontrol that relate directly to alcohol use. Impaired control (i.e., diffi culty adhering to limits on alcohol use; Heather et al., 1993) has been viewed as a hallmark of substance dependence (Levine, 1978; O'Brien et al., 2006) and is pertinent to young drinkers given its relatively early emergence (Chick and Duffy, 1979; Chung and Martin, 2002, 2005; Langenbucher and Chung, 1995; Leeman et al., in press). Self-reported impaired control is predictive of alcohol-related problems, cross-sectionally (Leeman et al., 2007; Nagoshi, 1999; Patock-Peckham et al., 2001) and prospectively (Leeman et al., 2009b), and heavy episodic drinking cross-sectionally in undergraduates (Leeman et al., 2007). "
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    ABSTRACT: Expectancies of alcohol's effects have been associated with problem drinking in undergraduates. If subgroups can be classified based on expectancies, this may facilitate identifying those at highest risk for problem drinking. Undergraduates (N = 612) from two state universities completed a web-based survey. Responses to the Comprehensive Effects of Alcohol scale were analyzed using k-means cluster analysis separately within each university sample. Hartigan's heuristic was used to determine that five was the optimal number of clusters in each sample. Clusters were distinguishable based on their overall magnitude of expectancy endorsement and by a tendency to endorse stronger positive than negative expectancies. Subsequent analyses were conducted to compare clusters on alcohol involvement and trait disinhibition. A cluster characterized by endorsement of positive and negative expectancies ("strong expectancy") was associated with a particularly problematic risk profile, specifically concerning difficulties with self-control (i.e., trait disinhibition and impaired control over alcohol use). A cluster with higher positive and lower negative expectancies reported frequent heavy drinking but appeared to be at lower risk than the strong expectancy cluster in a number of respects. Negative expectancy endorsement appeared to represent added risk above and beyond positive expectancies. Results suggest that both the magnitude and combination of expectancies endorsed by subgroups of undergraduate drinkers may relate to their risk level in terms of alcohol involvement and personality traits. These findings may have implications for interventions with young adult drinkers.
    Journal of studies on alcohol and drugs 03/2012; 73(2):238-49. DOI:10.15288/jsad.2012.73.238 · 2.76 Impact Factor
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    • "One primary misfit between SUDs and APEDs misuse are the definitions and role of tolerance and withdrawal. Both features are linked to hedonic drives and the neurobiology of addiction is based off these opponent processes (O'Brien et al., 2006) and their translational counterparts of reward and anti-reward (Koob and Le Moal, 2008). However, the function of tolerance and withdrawal among APED users is more clearly linked to regulation and adaptation of the HPG axis and its influence over muscle mass. "
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    ABSTRACT: Appearance and performance enhancing drug (APED) use includes the use of a range of pharmacologically distinct substances and concurrent investment in outward appearance or achievement, dietary control, and frequent exercise. A number of existing reviews and conceptual papers have defined pathological forms of APED use within the APED class of anabolic-androgenic steroids (AASs) and using the framework of AAS dependence. We review published data on APED use including human studies of AAS users and identified three defining phenomenological features associated with increased health risk and pathology. These features included (1) polypharmacy or the concurrent use of several pharmacologically distinct substances used to change outward appearance or increase likelihood of personal achievement; (2) significant body image disturbance; (3) rigid practices and preoccupations with diet and exercise. Investigations into the latent structure of APED use suggest these features cluster together in a homogenous group of APED users who have the highest health risk and most psychopathology. These features are discussed in the context of AAS dependence and problems with defining classic tolerance-withdrawal symptoms among APED users. Suggestions for a resolution and outline for future research needed to determine the best system for identifying and diagnosing pathological APED use are discussed.
    Drug and alcohol dependence 03/2011; 114(1):1-11. DOI:10.1016/j.drugalcdep.2010.09.018 · 3.42 Impact Factor
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