Preaddiction—A Missing Concept for Treating Substance Use Disorders

Abstract

psychedelics to quickly mushroom beyond what is safe. While offlabel use may be a useful way to provide access to promising treatments, it must be done responsibly and with an eye toward future evidence-based advancements in medical science; regulators, policy makers, and health authorities must carefully examine and create guardrails for the promotion and off-label use of psychedelics.

Ultra-Processed Food Addiction: An Epidemic?

“…Given that the individual risk profile for addiction (e.g., genetic profile, trauma exposure) does not quickly change on a population level, the increased prevalence rates of SUDs are primarily attributable to the addictive potency of the substance and accessibility within the surrounding environment. While the addictive substance is most problematic to those who develop a SUD, broader public health risks exist due to the potential for widespread subclinical overconsumption that results in negative health consequences [117]. Addictive substances (particularly legal ones) are highly profitable and the industries (or individuals) that produce and sell these addictive substances benefit.…”

Addictive and other mental disorders: a call for a standardized definition of dual disorders

“…It is evident that, despite the advantages of having a categorical diagnostic system based on the observation of psychopathological phenomena, just as Kraepelin did in the early days of psychiatry, ca. 1915 [85], the lack of sensitivity and reliability makes it difficult to capture the broad spectrum of mental symptom manifestations and the relationships between them [86]. This helps explain why the DSM and ICD have systematically and consistently overlooked DD across successive revisions.…”

“…Somewhat paradoxically, a DD-based framework would also be consistent with DSM and ICD polythetic criteria whereby specific mental disorders are defined by multiple symptoms, not all of which need to be present or currently active (e.g., in a "preaddiction" stage [86] or when a SUD is in early or sustained remission) to consider a mental disorder present in a specific individual [97]. Thus, the term DD is compatible with DSM/ICD operational definitions whereby DD represent not only the temporary coexistence of different disorders but also the sequential events that manifest themselves at different points along the life span and the course of a person's mental illness.…”

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“…Two recent papers highlight the importance of labeling less severe forms of addiction. The first paper by McLellan et al, uses the phrase "preaddiction" to refer to mild and moderate cases of SUD [6]. They point to the success of the term prediabetes to help engage people with early-stage diabetes before severe consequences set in.…”