April 2009
Charles O'Brien, M.D., Ph.D.
This group held its last two-day, in-person meeting in February, 2009, and has continued meeting via conference call twice monthly. The group has been making progress in the following areas:
1. A dimensional approach to measuring severity via symptom count is being considered.
2. Consideration is being given to development of a separate set of criteria for cannabis withdrawal.
3. A subgroup on terminology was formed to address the current controversy regarding use of the terms: “abuse”, “dependence”, and “addiction”. A survey of stakeholders is being developed to test any changes in terminology. The test populations will include clinicians in the treatment field, primary care clinicians, researchers, patients and their families.
4. A potential outline being considered for the chapter includes:
a. Substance Use Disorders with a description for each such as Alcohol Use Disorder – Mild, Moderate, Severe
b. Substance Intoxication and Withdrawal
c. Substance-Induced Mental Disorders
In addition to these substance-related disorders, the group is exploring whether evidence exists to include non-substance addictions (also referred to as “behavioral addictions” or “appetitive disorders”) within the chapter. A chapter section focused on this might discuss the possibility of other behavior disorders that in some ways resemble substance use disorders particularly because they involve appetitive behavior that is out of control.
5. The concept of craving will be described in the chapter, though it is unlikely that it would be used as a criterion for diagnosis.
6. A description of tolerance and physical dependence on prescription medications will likely be included in the chapter, but if so, this form of physiological dependence will be clearly distinguished from substance use disorder.