in the translation to American English. Edwards & Gross
differentiated between dependence severity (related to
drinking behavior) and the severity of the consequences
of drinking . The latter could be influenced by culture
and/or comorbid psychopathology; but the former was
more explicitly related to alcohol addiction. Edwards and
colleagues, as well as others, demonstrated the utility of
dependence severity in predicting the possibility of a
moderate drinking outcome  in studies of heritability
 and in clinical laboratory research [11,12]. The
DSM-III-R Committee, following the paradigmatic direc-
tive of the American Psychiatric Association, collapsed
the two-dimensional syndrome into a single category;
and in the absence of any comparable data supporting
the construct across all addictions, applied the category
to all abused substances. DSM-V now plans to expand the
category to gambling and potentially other non-drug
addictions—seemingly without considering important
differences among different addictions and/or the rel-
evance of specific psychosocial consequences to each
However, back to Dr O’Brien’s essay and its enthusias-
tic refocus on the term ‘addiction’. Would a rose by
another name smell just as sweet ? Sadly, since DSM-
III-R, we have lost sight of the meaning of the term in a
thicket of psychosocial criteria. With DSM-V, it is hard to
smell the rose!
Declaration of interests
Addiction, dependence, DSM V.
ROGER E. MEYER
Best Practice Project Management, Inc., PO Box 30219
Bethesda, MD 20814, Bethesda, MD 20824, USA.
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13. Shakespeare W. Romeo and Juliet Act II Scene II.
A WELCOME CHANGE THAT STOPS
SHORT OF BEING FULLY SATISFYING
medicine practitioners, physical dependence, character-
ized by tolerance and withdrawal, remains key to the
concept of . . . oops, I almost said it: addictive disorders.
Of course, we in fact know that addiction is a motiva-
tional and behavioral disorder, rather than anything
else. It results from maladaptive changes within at least
three main brain modules. First, the ‘go-for-it module’,
comprising classical brain reward circuitry, motivates
approach behavior in ways normally utilized to obtain
natural rewards, but potentially energized more power-
fully by drugs. Secondly, the ‘stay-away-from-it module’,
utilizing the amygdala complex and other structures
involved in negative emotions appropriately motivates
mately becomes pathologically turned on by drug use,
setting the scene for negatively reinforced drug seeking.
Finally, the evolutionarily most recent ‘let’s-stop-and-
think-about-it module’ is critical for taking the temporal
distance of rewards into account, but may end up priori-
tizing the quick fix over more distant natural rewards, as
a result of genetic predisposition, developmental stage or
drug-inflicted damage to the frontal lobes [1–3]. None of
this has much to do with, for instance, the tremors of the
ship between the individual and the drug, of which
© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction
Addiction, 106, 868–897