Am J Psychiatry 156:41-49, January 1999
©Copyright 1999 American Psychiatric Association
Clinical Implications for Four Drugs of the DSM-IV Distinction Between Substance Dependence With and Without a Physiological Component
Marc A. Schuckit, M.D.,
Jean-Bernard Daeppen, M.D.,
George P. Danko, Ph.D.,
Megan L. Tripp, B.A.,
Tom L. Smith, Ph.D.,
Ti.-K. Li, M.D.,
Victor M. Hesselbrock, Ph.D., and
Kathleen K. Bucholz, Ph.D.
OBJECTIVE: The DSM-IV work group asked researchers and clinicians to subtype substance dependent individuals according to the presence or absence of physiological symptoms. A recent report from the Collaborative Study on the Genetics of Alcoholism demonstrated that among alcohol-dependent men and women, a history of tolerance or withdrawal was associated with a more severe clinical course, especially for individuals with histories of alcohol withdrawal. This article evaluates similar distinctions among subjects in the collaborative study who were dependent on marijuana, cocaine, amphetamines, or opiates. METHOD: Structured interviews gathered information from 1,457 individuals with a lifetime diagnosis of marijuana dependence, 1,262 with histories of cocaine dependence, 647 with amphetamine dependence, and 368 subjects with opiate dependence. For each drug, the clinical course was compared for subjects whose dependence included a history of withdrawal (group 1), those dependent on each drug who denied withdrawal but reported tolerance (group 2), and those who denied both tolerance and withdrawal (group 3). RESULTS: The proportion of dependent individuals who denied tolerance or withdrawal (group 3) ranged from 30% for marijuana to 4% for opiates. For each substance, individuals in groups 1 and 2 evidenced more severe substance-related problems and at least a trend for greater intensities of exposure to the drug; those reporting withdrawal (group 1) showed the greatest intensity of problems. CONCLUSIONS: The designation of dependence in the context of tolerance or withdrawal identifies individuals with more severe clinical histories. These results support the importance of the designation of a physiological component to dependence, especially for people who have experienced a withdrawal syndrome.
This article has been cited by other articles:
|
|
|
|
 
A. J. Budney, J. R. Hughes, B. A. Moore, and R. Vandrey
Review of the Validity and Significance of Cannabis Withdrawal Syndrome
Am J Psychiatry,
November 1, 2004;
161(11):
1967 - 1977.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Schuckit, T. L. Smith, G. P. Danko, K. K. Bucholz, T. Reich, and L. Bierut
Five-Year Clinical Course Associated With DSM-IV Alcohol Abuse or Dependence in a Large Group of Men and Women
Focus,
April 1, 2003;
1(2):
163 - 170.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Schuckit, T. L. Smith, G. P. Danko, K. K. Bucholz, T. Reich, and L. Bierut
Five-Year Clinical Course Associated With DSM-IV Alcohol Abuse or Dependence in a Large Group of Men and Women
Am J Psychiatry,
July 1, 2001;
158(7):
1084 - 1090.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
M. A. Schuckit, T. L. Smith, and N. A. Landi
The 5-Year Clinical Course of High-Functioning Men With DSM-IV Alcohol Abuse or Dependence
Am J Psychiatry,
December 1, 2000;
157(12):
2028 - 2035.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
K. M. Kampman, J. R. Volpicelli, A. I. Alterman, J. Cornish, and C. P. O’Brien
Amantadine in the Treatment of Cocaine-Dependent Patients With Severe Withdrawal Symptoms
Am J Psychiatry,
December 1, 2000;
157(12):
2052 - 2054.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
M. A. SCHUCKIT, T. L. SMITH, J. KALMIJN, J. TSUANG, V. HESSELBROCK, and K. BUCHOLZ
RESPONSE TO ALCOHOL IN DAUGHTERS OF ALCOHOLICS: A PILOT STUDY AND A COMPARISON WITH SONS OF ALCOHOLICS
Alcohol Alcohol.,
May 1, 2000;
35(3):
242 - 248.
[Abstract]
[Full Text]
[PDF]
|
|
|
Get information about faster international access.
Privacy Policy
Copyright © 1999
American Psychiatric Association.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
