Clinical Implications for Four Drugs of the DSM-IV Distinction Between Substance Dependence With and Without a Physiological Component

Abstract

Objective: The DSM-IV work group asked researchers and clinicians to subtype substance dependent individuals according to the presence or absence of physiological symptoms. A recent report from the Collaborative Study on the Genetics of Alcoholism demonstrated that among alcohol-dependent men and women, a history of tolerance or withdrawal was associated with a more severe clinical course, especially for individuals with histories of alcohol withdrawal. This article evaluates similar distinctions among subjects in the collaborative study who were dependent on marijuana, cocaine, amphetamines, or opiates. Method: Structured interviews gathered information from 1,457 individuals with a lifetime diagnosis of marijuana dependence, 1,262 with histories of cocaine dependence, 647 with amphetamine dependence, and 368 subjects with opiate dependence. For each drug, the clinical course was compared for subjects whose dependence included a history of withdrawal (group 1), those dependent on each drug who denied withdrawal but reported tolerance (group 2), and those who denied both tolerance and withdrawal (group 3). Results: The proportion of dependent individuals who denied tolerance or withdrawal (group 3) ranged from 30% for marijuana to 4% for opiates. For each substance, individuals in groups 1 and 2 evidenced more severe substance-related problems and at least a trend for greater intensities of exposure to the drug; those reporting withdrawal (group 1) showed the greatest intensity of problems. Conclusions: The designation of dependence in the context of tolerance or withdrawal identifies individuals with more severe clinical histories. These results support the importance of the designation of a physiological component to dependence, especially for people who have experienced a withdrawal syndrome.(Am J Psychiatry 1999; 156:41-49)

Commentary on the Comorbidity of Alcohol Use Disorder and Depression among Patients Attending a Tertiary Hospital in the Niger Delta Region of Nigeria

“…This view has been supported by other researchers [13]. This stressdiathesis etiological model of psychiatric disorders is very applicable to the AUD/Depression co-morbidity.…”

The Neuropsychology of Cocaine Addiction: Recent Cocaine Use Masks Impairment

“…In addition, we examined the extent to which dysphoric symptoms affect NP function, since depression/ dysphoria is a common psychostimulant withdrawal symptom (Association, 2000). Depression/dysphoria is also associated with more severe dependence (Schuckit et al, 1999;Sofuoglu et al, 2003), exacerbating NP deficits in drug-abusing (Di Sclafani et al, 2002) and non-drug abusing (Fossati et al, 2002) populations.…”

Reliability of DSM-IV diagnostic criteria using the semi-structured assessment for drug dependence and alcoholism (SSADDA)

“…In addition, withdrawal is based on more dramatic and perhaps more reliably reported symptoms than is tolerance, a characteristic that could be important when establishing a history of the phenomena retrospectively. Finally, the problem with tolerance might relate to the definition used; for example, a 50% increase in the amount of the substance needed for an effect might be a relatively low threshold (Schuckit et al, 1999).…”