Defining Substance Use Disorders: Do We Really Need More Than Heavy Use?

Rehm, Jüergen; Marmet, Simon; Anderson, Peter; Gual, Antoni; Kraus, Ludwig; Nutt, David; Room, Robin; Samokhvalov, Andriy V.; Scafato, Emanuele; Trapencieris, M.; Wiers, Reinout W.; Gmel, Gerhard

doi:10.1093/alcalc/agt127

Cited by 204 publications

(165 citation statements)

References 70 publications

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“…The article by Rehm and Room (2017) elaborates and continues the argument presented earlier by the authors and a number of other colleagues (Rehm et al, 2013). Criticising the use of diagnostic criteria oriented to the ICD-10 and DSM-5 in the global burden of disease (GBD) collaboration, they argue that the best, most reliable and comparative indicator of harm to health from alcohol use in a population is the level of consumption and its pattern; the latter meaning its concentration in average drinking occasions.…”

supporting

confidence: 63%

Comment on Rehm and Room

Sulkunen

2017

Nordic Studies on Alcohol and Drugs

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supporting

confidence: 63%

Comment on Rehm and Room

Sulkunen

2017

Nordic Studies on Alcohol and Drugs

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“…In addition, the higher relative risks for alcohol use disorders or alcohol problems may serve as an indirect indicator 86, 87, as both are usually linked to heavy drinking occasions 40, 89, 90.…”

Section: Resultsmentioning

confidence: 99%

The relationship between different dimensions of alcohol use and the burden of disease—an update

et al. 2017

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Background and aimsAlcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs).MethodsSystematic review of reviews and meta‐analyses on alcohol consumption and health outcomes attributable to alcohol use.For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others.ResultsIn total, 255 reviews and meta‐analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD‐10 three‐digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in‐depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently.ConclusionsResearch since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.

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“…Obviously, less regulation of psychoactive substances may lead to their greater availability, and therefore greater harm (as evidenced for alcohol [4] and prescription opioids [5]; for Canada see [6]), but there are differences in the pharmacological and toxicological properties of the substances [7,8]. An important epidemiological indicator in this regard would be harm per user or harm per heavy user [9], which would also suggest cannabis as having lesser harm potential than alcohol, tobacco or prescription opioids in Canada. Based on the data presented in our study [2], one death per 10 000 users would be expected for cannabis, whereas the corresponding estimates for alcohol, tobacco and prescription opioids would be considerably higher (four, 100 and three deaths per 10 000 users, respectively).…”

Section: On the Relationship Between Epidemiology And Policymentioning

confidence: 99%

On the relationship between epidemiology and policy

et al. 2016

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K the knowledge base into consideration. For instance, there is far more accumulated evidence on alcohol and chronic disease risks [14,15] than similar evidence on cannabis [16]. This is due, in part, to the greater availability of alcohol, and thus data could be integrated more easily into large medical cohort studies. This situation will improve with a more evidence-based approach to drug policies in the future. Therefore, policies can, by no means, be derived exclusively from epidemiological results per se, but should be informed by such results. Declaration of interestsNone.

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Defining Substance Use Disorders: Do We Really Need More Than Heavy Use?

Abstract: 'Heavy substance use over time' seems to be a definition of substance use disorders in line with results of basic research and epidemiology. Additionally, it reduces stigmatization. This approach should thus be further explored.

Cited by 204 publications

References 70 publications

Comment on Rehm and Room

Comment on Rehm and Room

The relationship between different dimensions of alcohol use and the burden of disease—an update

On the relationship between epidemiology and policy

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