Can We Simplify the Definition of Substance Use Disorder?

Substance use disorder is the term used by the American Psychiatric Association to officially define both substance addiction and clinically significant substance abuse. Since May 2013, doctors in the U.S. have begun using this term when diagnosing their patients. In order to receive a substance use disorder diagnosis, an individual must meet a certain set of relatively detailed criteria. In a study published in December 2013 in the journal Alcohol and Alcoholism, a multinational research team looked at what happens when a single criterion—heavy substance intake—replaces the more complicated definition currently in use.

Substance Use Disorder Basics

The substance use disorder diagnosis was specifically designed to allow doctors to simultaneously address both addiction and non-addicted dysfunctional substance abuse in their patients. It replaces the diagnostic format previously used by the American Psychiatric Association, which treated addiction and clinically significant abuse as distinct, separate issues. As a rule, doctors identify the particular substance causing problems for a given individual. For example, a person affected by serious alcohol-related issues has alcohol use disorder, while a person affected by serious amphetamine-, methamphetamine- or cocaine-related issues has stimulant use disorder.

All people diagnosed with substance use disorder have a minimum of two or three and a maximum of 11 specific symptoms. Prominent examples of these symptoms include substance cravings, an inability to curb substance intake, the development of tolerance to a substance’s effects, serious life disruptions that stem from substance use, use of substances in clearly dangerous circumstances and devotion of significant time or resources to either using a substance or recovering from substance intake. People affected by the minimum number of symptoms have mild substance use disorder, while people affected with many or most of the required symptoms have major or severe substance use disorder.

Heavy Substance Intake

Heavy substance intake is a term used to define a level of substance intake that exceeds safe use and puts an individual at risk for experiencing clearly negative short- or long-term consequences. The classic example here is heavy alcohol intake, a level of alcohol consumption that exceeds the maximum daily or weekly limit set by commonly accepted public health guidelines. However, users of any given addictive substance can take enough of that substance to steeply boost their chances of developing problems with abuse or addiction. Generally speaking, heavy users of a substance consume that substance on a regular basis and/or consume unusually large amounts of a substance either in isolated instances or as a matter of habit.

The Effects of Simplification

Some doctors and researchers believe that a relatively complicated definition of substance use disorder might not translate very well from culture to culture. In addition, some doctors and researchers believe that the terms currently used to define the disorder may have an unintentional stigmatizing effect on affected individuals. The authors of the study published in Alcohol and Alcoholism—who came from institutions located in Canada, Switzerland, Germany, Latvia, Great Britain, Australia, Spain, Sweden, Italy and the Netherlands—wanted to determine if heavy substance intake alone can effectively take the place of the 11 symptoms currently used to diagnose substance use disorder. These researchers were motivated by a desire to avoid any problems with stigmatization or cultural translation.

The researchers conducted an extensive review of the current state of scientific knowledge regarding the effects of heavy substance use. After completing this review, they made a couple of important findings. First, they concluded that heavy substance intake is a key underlying factor in the brain changes that contribute to the onset of substance use disorder. In addition, they concluded that habitual heavy substance intake is a critical factor in both substance-related illnesses and substance-related fatalities, as well as in most of the social problems associated with substance use.

As a result of their findings, the study’s authors believe that, by itself, heavy substance intake sufficiently captures the most important elements in the formation of substance use disorder. They also believe that the use of such a simple definition for diagnosing the condition could widen the usefulness of substance use disorder as a concept, while simultaneously lowering the chances that people diagnosed with the condition will feel targeted or stigmatized. Finally, the authors believe that future researchers should continue to investigate this issue as a potential step toward making heavy substance use the sole or main basis for diagnosing substance use disorder.

Posted on March 21st, 2014
Posted in Drug Addiction

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