Commonalities and Differences Across Substance Use Disorders: Phenomenological and Epidemiological Aspects

Abstract

Background Although psychoactive substances vary in many ways, they have important commonalties, particularly in their ability to lead to an addiction syndrome. The field lacks an updated review of the commonalities and differences in the phenomenology of alcohol, cannabis, tobacco, stimulants, opioids, hallucinogens, sedatives/tranquilizers and inhalants and their related substance use disorders (SUD). Methods DSM-IV and DSM-5 SUD diagnostic criteria were reviewed, as was evidence from recent epidemiological and clinical research: psychometric studies (test-retest reliability, latent trait analysis); physiological indicators (tolerance, withdrawal); prevalence and age of onset. Information was incorporated from previous reviews, PubMed and Scopus literature searches, and data from large U.S. national surveys. Results Empirical evidence in the form of test-retest reliability and unidimensionality supports use of the same DSM-IV dependence or DSM-5 SUD diagnostic criteria across substances. For most substances, the criteria sets were generally most informative in general population samples at moderate-to-severe levels of SUD. Across substances, two criteria (tolerance and use in hazardous situations) were identified as functioning differently in population subgroups. Since substances have different pharmacological effects, withdrawal is assessed using substance-specific symptoms, while tolerance is not; issues remain with the assessment of tolerance. Alcohol, tobacco, and cannabis were consistently identified as the substances with earliest onset of use, highest prevalence of lifetime use, and highest prevalence of lifetime disorder. Conclusions Despite differences between psychoactive substances, the generic DSM criteria set appear equally applicable across substances. Additional studies of tolerance and hazardous use will be useful for future nosologies. Alcohol, cannabis, and tobacco are the substances with the greatest public health impact due to the high prevalence and early onset of their use, and the potential all three substances have to lead to addiction.

Exploring the latent trait of opioid use disorder criteria among frequent nonmedical prescription opioid users

“…It is possible that these groups may respond to different interventions, however such conclusions would require a clinical study. The present study did not find very different phenotypes of individuals among frequent nonmedical prescription opioid users (i.e., physical versus psychological), but the phenotypes found in this study are within the OUD continuum, which could corroborate with the findings of the several studies evaluating the dimensionality of the DSM-5 Substance Use Disorder (Shmulewitz et al 2015). However, it is undeniable that both symptomatic classes described in this study have very different socio-demographic correlates, and present an important differentiation in regards to prescription opioids sources (doctor shopping versus family).…”

Using Factor Mixture Models to Evaluate the Type A/B Classification of Alcohol Use Disorders in a Heterogeneous Treatment Sample

“…Classification of AUDs has been approached from the perspective of DSM-IV and DSM-5 criteria (e.g., Harford & Muthén, 2001; Harford et al, 2009; Shmulewitz D, Greene ER, & Hasin D, 2015), drinking severity (Helzer et al, 2007;), and internalizing—externalizing psychopathology (Jenkins et al, 2011). Each perspective offers value for understanding the heterogeneity in drinking populations and identifying those with the greatest clinical risk, and our data suggest interesting options for synthesizing these nosological frameworks.…”

“…Other studies indicate separate abuse and dependence dimensions that drive the diagnostic criteria (Harford & Muthén, 2001), particularly when accounting for item biases related to gender, age, and race/ethnicity (Harford et al, 2009). Extensions of these models have been used to establish reliability of this unidimensional severity construct across substance using populations (Shmulewitz, Greene, & Hasin, 2015). …”

Funcionamento cognitivo, variáveis de uso e critérios diagnósticos do transtorno por uso de cocaína: um estudo envolvendo a correlação entre diferentes medidas de gravidade e suas implicações prognósticas

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