Definitions of Addiction

Diagnostic Criteria for Addiction (If you NEED HELP WITH YOUR OR A LOVED ONE's ADDICTION, please CALL toll-free (872) 666-9868 - compassionate people are waiting for your call right now ! )

The diagnostic criteria for addiction, as described in the DSM, have evolved from the first edition published in 1952 to DSM-IV, with a shift from an emphasis on the criteria of tolerance and withdrawal to other criteria which are more directed at compulsive use. The criteria for Substance Use Disorders outlined in the DSM-IV closely resemble those outlined in the International Statistical Classification of Diseases and Related Health Problems (ICD-10) for Drug Dependence (World Health Organization, 1992; Table 1.1). The DSM-5 was published in 2013 (American Psychiatric Association, 2013). In this, the criteria for drug addiction have changed both conceptually and diagnostically. The new diagnostic criteria for addiction merge the abuse and dependence constructs (i.e., substance abuse and substance dependence) into one continuum that defines “substance use disorders” on a range of severity, from mild to moderate to severe, based on the number of criteria that are met out of a total of 11. The severity of a substance use disorder (addiction) depends on how many of the established criteria are met by an individual. Mild Substance Use Disorder is the presence of 2–3 criteria, moderate is 4–5 criteria, and severe is six or more criteria. These criteria remain basically the same as in the previous edition of the DSM (DSM-IV) and ICD-10, with the exception of the removal of “committing illegal acts” and the addition of a new “craving” criterion. For example, rather than differentiating “alcoholics” and “alcohol abusers,” the new classification Substance Use Disorder on Alcohol encompasses individuals who are afflicted by the disorder to different degrees, from “mild” (e.g., a typical college binge drinker who meets two criteria, such as alcohol is often taken in larger amounts or over a longer period than was intended and there is a persistent desire or unsuccessful efforts to cut down or control alcohol use) to “severe” (e.g., a classic person with alcoholism who meets six or more criteria, such as a great deal of time spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects, recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home, alcohol use despite knowledge of having a persistent or recurrent physical or psychological problem, continued alcohol use despite persistent social or interpersonal problems, tolerance, and withdrawal).

The terms Substance Use Disorder and Addiction will be used interchangeably throughout this book to refer to a usage process that moves from drug use to addiction as defined above. Drug addiction is a disease and, more precisely, a chronic relapsing disease (Figures 1.1 and 1.2). The associated medical, social, and occupational difficulties that usually develop during the course of addiction do not disappear after detoxification. Addictive drugs produce changes in brain circuits that endure long after the person stops taking them. These prolonged neurochemical and neurocircuitry changes and the associated personal and social difficulties put former patients at risk of relapse, a risk that is > 60% within the first year after discharge.

FIGURE 1.1

Last-year use with abuse or dependence (data from Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2011; see Table 1.2).


FIGURE 1.2

Stages of addiction to drugs of abuse. Drug taking invariably begins with social drug taking and acute reinforcement and often, but not exclusively, moves in a pattern of use from escalating compulsive use to dependence, withdrawal, and protracted abstinence.

If you NEED HELP WITH YOUR OR A LOVED ONE's ADDICTION, please CALL toll-free (872) 666-9868 - compassionate and caring people are waiting for your call right now!

During withdrawal and protracted abstinence, relapse to compulsive use is likely to occur with a repeat of the cycle. Genetic factors, environmental factors, stress, and conditioning all contribute to the vulnerability to enter the cycle of abuse/dependence and relapse within the cycle. [Taken with permission from Koob GF, Le Moal M. Neurobiology of Addiction. Academic Press, London, 2006.]

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