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• W2038740125 abstract "If ‘Addiction and related disorders’ were a movie, instead of a proposed chapter for the DSM-V, I would award it three stars out of a possible four. It merits one star for reaffirming the fundamental unity of the field. In organization and language, it acknowledges that a range of legal and illegal substances can give rise to a similar pattern of compulsive and destructive behavior. If recurrent use of alcohol or nicotine leads to social problems, accident hazards and so on, then it qualifies for the ‘use disorder’ tag on the same basis as opiates, cocaine or cannabis. The criteria formally level the psychoactive-drug playing field, a trend evident in public health and addiction research in the last four decades. Indeed, the inebriety theorists of a century ago, physicians such as Thomas Crothers and Norman Kerr, would have commended the draft. Although they acknowledged different drug ‘habits’ or ‘-isms’ (e.g. ‘morphinism’), they recognized in the various addictions similar symptoms, a common neuropathology and serious social and moral consequences [1]. The proposed chapter merits a second star for ending the confusion surrounding ‘dependence’ and ‘addiction’. Alfred Lindesmith, another addiction research pioneer, remarked that an infant born to an addicted mother may be physiologically dependent but not an addict. By contrast, a detoxified adult user in prison may be temporarily non-dependent yet remain an addict. All addicts are dependent at some point in their careers, but dependence per se is not a sufficient cause of addiction. Lindesmith also observed that hospital patients dependent on opiates often failed to behave as addicts [2]. Charles O'Brien [3], citing similar recent research, draws the obvious moral: in order to minimize the risk of undertreating pain patients, choose language that avoids conflating iatrogenic dependence with iatrogenic addiction. The proposed chapter merits a third star for recommending the inclusion of gambling. If compulsive gambling and substance addictions involve the same neural pathways, respond to similar treatments (including, interestingly, the opiate antagonist naltrexone) and overlap epidemiologically and possibly genetically (compulsive gamblers being more prone to substance addictions), then they logically fall under the same DSM-V heading. The proposed chapter fails to merit a fourth star because it balks—inconsistently—at the word ‘addiction’. The new general heading is ‘Addiction and related disorders’. Yet particular manifestations go by ‘cocaine-use disorder’, ‘alcohol-use disorder’ and so on. This is like having a diagnostic category called ‘cancer’ and calling organ-specific manifestations ‘lung disorder’ and ‘breast disorder’. ‘Disorder’ is an appropriate noun for sequelae such as alcohol-induced sleep disorder, but both medical personnel and lay people will find ‘addiction’ a clearer and more satisfactory label for the general pathological condition characterized by compulsion and relapse. O'Brien is right to argue that common usage has rendered ‘addiction’ less pejorative. ‘Use disorder’ reads like a clumsy euphemism. It may also be a dangerous one. Imagine clinicians informing patients that they have a use disorder instead of an addiction. Which term is more likely to command their full attention? On 15 September 2010, the National Institutes of Health's Scientific Management Review Board (NIH SMRB) recommended a merger of the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). On 18 November 2010, NIH Director Francis Collins announced the formation of a task force to explore how NIDA and NIAAA, together with related programs scattered throughout the NIH, could be combined into a single new institute on ‘substance use, abuse, and addiction research’[4,5]. These developments are the clearest indications yet of the impulse towards the unified study and treatment of a related and often overlapping set of chronic relapsing diseases characterized by detectable and specific long-term changes in brain structure and function; by uncontrolled, compulsive use of drugs or recurrent destructive behaviors such as gambling; and by significant comorbidity with other mental and physical diseases. Neither the SMRB nor Collins shied away from using the word ‘addiction’ to describe the compulsive aspect. Those charged with revising the DSM-V should do likewise. None." @default.
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• W2038740125 date "2011-04-08" @default.
• W2038740125 modified "2023-09-27" @default.
• W2038740125 title "LANGUAGE-USE DISORDER: COMMENT ON DSM-V'S PROPOSED ‘ADDICTION AND RELATED DISORDERS’ AND CHARLES O'BRIEN'S ‘ADDICTION AND DEPENDENCE IN DSM-V’" @default.
• W2038740125 cites W1589966085 @default.
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• W2038740125 doi "https://doi.org/10.1111/j.1360-0443.2010.03285.x" @default.
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