An evaluation of the psychoactive substance dependence syndrome in its application to opiate users

Abstract

The Psychoactive Substance Abuse and Dependence (PSDA) section of the revised, 3rd edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-III-R) bears a close correspondence to the conceptualization of a dependence syndrome as posited by Edwards, Arif & Hodgson (1981). Further, DSM-III-R represents a major shift in psychodiagnostics. The present study investigated hypothesized properties of the dependence syndrome and examined the characteristics of DSM-III-R criteria with a sample of opiate users. Findings indicated general support for the unidimensional postulate of the dependence syndrome but did not support the weighting of syndrome elements within DSM-III-R. The implications of such findings for the proposed DSM-IV are discussed.

Factor structures for DSM‐IV substance disorder criteria endorsed by alcohol, cannabis, cocaine and opiate users: results from the WHO reliability and validity study

“…More recent work which applied DSM-IV dependence criteria in a sample recruited from alcohol and drug treatment services found unidimensional solutions for cannabis, in addition to alcohol, cocaine, opiates, sedatives and stimulants but not for hallucinogens (Morgenstern, Langenbucher & Labouvie, 1994). Other studies using treatment samples and assessing DSM-III-R dependence criteria have also shown unidimensional solutions among cocaine (Bryant et al, 1991) and opiate (Stripp et al, 1990) users. Non-treatment samples of cocaine, opiate and amphetamine users (Gossop et al, 1995) have also shown unidimensional solutions.…”

“…Initial research addressing these issues focused on substance dependence and used samples from treatment settings (Chick, 1980;Kosten et al, 1987;Hasin et al, 1988;Davidson, Bunting & Raistrick, 1989;Caetano, 1990;Stripp et al, 1990;Bryant, Rounsaville & Babor, 1991;Morgenstern, Langenbucher & Labouvie, 1994) with samples from community settings (Gossop et al, 1995;Johnson, Breslau & Anthony, 1996) appearing in the literature more recently. Differences in items chosen for evaluation, sample sizes, sampled populations and statistical methods are likely to have contributed to the lack of consensus among early studies.…”

Construct validity of the dependence syndrome as measured by DSM-IV for different psychoactive substances

“…introduction of an alcohol dependence syndrome construct, and their delineation of the elements comprising the syndrome, have been influential in the substance abuse field. The subsequent proposition that the syndrome may be applicable to drug dependence as well as to alcohol dependence, resulting in a broader substance abuse dependence syndrome, has gained wide acceptance (Kosten et al, 1987;Stripp et al, 1990). Indeed, the elements of the dependence syndrome provide the theoretical framework for the diagnostic criteria associated with dependence on psychoactive substances in several major diagnostic systems, the 0965-2140/95/121661-09…”

Substance use disorders in the DSM-IV.

“…The construct of a substance dependence syndrome seems to be valid for drugs other than alcohol, the drug for which the construct was originally developed (e.g., Phillips et al, 1987;Stripp, Burgess, Pattison, Pead, & Holman, 1990;Sutherland et al, 1986). The syndrome has also been independently validated for alcohol by research workers other than Edwards and his colleagues (e.g., Babor, Cooney, & Lauerman, 1987; Drummond, 1990).…”