Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-24T09:01:56.306Z Has data issue: false hasContentIssue false
  • English
  • Français

Substance-Use Disorders in DSM-III-R

Evidence for the Dependence Syndrome Across Different Psychoactive Substances

Published online by Cambridge University Press:  02 January 2018

Thomas R. Kosten ,
Bruce J. Rounsaville ,
Thomas F. Babor ,
Robert L. Spitzer  and
Janet B. W. Williams
Thomas R. Kosten*
Affiliation:
Yale University School of Medicine, Department of Psychiatry, Substance Abuse Treatment Unit, in the Connecticut Mental Health Center and APT Foundation; affiliation as for first two authors, and University of Connecticut School of Medicine, Department of Psychiatry; affiliation as for first two authors, and Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, Department of Psychiatry
Bruce J. Rounsaville
Affiliation:
Yale University School of Medicine, Department of Psychiatry, Substance Abuse Treatment Unit, in the Connecticut Mental Health Center and APT Foundation; affiliation as for first two authors, and University of Connecticut School of Medicine, Department of Psychiatry; affiliation as for first two authors, and Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, Department of Psychiatry
Thomas F. Babor
Affiliation:
Yale University School of Medicine, Department of Psychiatry, Substance Abuse Treatment Unit, in the Connecticut Mental Health Center and APT Foundation; affiliation as for first two authors, and University of Connecticut School of Medicine, Department of Psychiatry; affiliation as for first two authors, and Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, Department of Psychiatry
Robert L. Spitzer
Affiliation:
Yale University School of Medicine, Department of Psychiatry, Substance Abuse Treatment Unit, in the Connecticut Mental Health Center and APT Foundation; affiliation as for first two authors, and University of Connecticut School of Medicine, Department of Psychiatry; affiliation as for first two authors, and Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, Department of Psychiatry
Janet B. W. Williams
Affiliation:
Yale University School of Medicine, Department of Psychiatry, Substance Abuse Treatment Unit, in the Connecticut Mental Health Center and APT Foundation; affiliation as for first two authors, and University of Connecticut School of Medicine, Department of Psychiatry; affiliation as for first two authors, and Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, Department of Psychiatry
*
APT Foundation, Suite IA, 904 Howard Avenue, New Haven, Ct. 06511, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Using the newly revised DSM-III-R criteria for substance-abuse diagnoses, we examined dependence syndrome elements among 83 psychiatric patients. The sample included 14 with no history of substance abuse. The remainder abused alcohol (52), sedatives (31), hallucinogens (12), stimulants (33), cannabis (44), cocaine (52), or opiates (47). Many patients (52) had abused more than one type of drug. Ten items assessing the proposed dependence symptoms for each type of drug were factor-analysed. The dependence syndrome items formed a single factor for opiates, cocaine, and alcohol, but not for other drugs. When the items were combined into cumulative scales, they had excellent internal consistency. Furthermore, they formed good approximations of unidimensional Guttman scales on which higher scores indicated greater syndrome severity. The items associated with higher scores differed across drugs, with opiates having the most striking differences from the other substances. Medical-psychosocial consequences were relatively independent of the dependence syndrome, although alcohol and cocaine dependence had some association with other problem areas. These findings support the utility of a common dependence syndrome concept for drugs of abuse as well as alcohol, and provide empirical support for the current revision of the DSM-III diagnostic criteria.

Type
Papers
Information
The British Journal of Psychiatry , Volume 151 , Issue 6 , December 1987 , pp. 834 - 843
Copyright
Copyright © Royal College of Psychiatrists, 1987 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. Washington, DC: American Psychiatric Association.Google Scholar
Chein, I., Gerard, D. L., Lee, R. S. & Rosenfeld, E. (1964) The Road to H. New York: Basic Books.Google Scholar
Chick, J. (1980) Alcohol dependence: methodological issues in its measurement, reliability of the criteria. British Journal of Addictions, 75, 175–186.Google Scholar
Cronbach, L. J. & Furby, L. (1970) How should we measure “change” - or should we? Psychological Bulletin, 74, 16–21.Google Scholar
Edwards, G. (1986) The alcohol dependence syndrome: a concept as stimulus to enquiry. British Journal of the Addictions, 81, 171–183.CrossRefGoogle ScholarPubMed
Edwards, G., Arif, A. & Hodoson, R. (1981) Nomenclature and classification of drug- and alcohol-related problems: a WHO memorandum. Bulletin of the World Health Organization, 59, 225–242.Google Scholar
Edwards, G., Arif, A., Hodoson, R. & Gross, M. M. (1976) Alcohol dependence: provisional description of the clinical syndrome. British Medical Journal, 1, 1058–1061.Google Scholar
Foy, D. W., Nunn, L. B. & Rychtajuk, R. G. (1984) Broad-spectrum behavioral treatment for chronic alcoholics: effects of training controlled drinking skills. Journal of Consulting and Clinical Psychology, 52, 218–230.Google Scholar
Gawin, F. H. & Kleber, H. D. (1986) Abstinence symptomatology and psychiatric diagnosis among cocaine abusers. Archives of General Psychiatry, 43, 107–113.Google Scholar
Guttman, L. A. (1944) A basis for scaling quantitative data. American Sociological Review, 9, 139–150.CrossRefGoogle Scholar
Heather, N., Rollnick, S. & Winton, M. (1983) A comparison of objective and subjective measures of alcohol dependence as predictors of relapse following treatment. British Journal of Clinical Psychology, 22, 11–17.Google Scholar
Hesselbrock, M., Babor, T. F., Hesselbrock, V., Meyer, R. E. & Workman, K. (1983) “Never believe an alcoholic”? On the validity of self-report measures of alcohol dependence and related constructs. International Journal of Addiction, 18, 593–609.CrossRefGoogle ScholarPubMed
Hubbard, R. L., Allison, M., Bray, R. M. et al (1983) An overview of client characteristics, treatment services, and during treatment outcomes for out-patient methadone clinics in the treatment outcome prospective study (TOPS). In Research on the Treatment of Narcotic Addiction - State of the Art (eds J. R. Cooper, F. Altman, B. S. Brown & D. Czechowicz). Rockville, Md: National Institute on Drug Abuse.Google Scholar
Kendell, R., Babor, T., Jablensky, A. et al (1986) Report of the strategic core group on diagnosis and classification of alcohol-and drug-related problems. Geneva: World Health Organization.Google Scholar
Kosten, T. R., Rounsaville, B. J. & Kleber, H. D. (1983) Concurrent validity of the Addiction Severity Index. Journal of Nervous and Mental Disease, 171, 606–610.Google Scholar
Litman, G. K., Eiser, J. R., Rawson, N. S. B. & Oppenheim, A. N. (1979) Differences in relapse précipitants and coping behaviors between alcoholic relapsers and survivors. Behavioral Research and Therapy, 17, 89–94.Google Scholar
Marlatt, G. A. & Gordon, J. R. (1980) Determinants of relapse: implications for the maintenance of behavior change. In Behavioral Medicine: Changing Health Lifestyles (eds P. O. Davidson & S. M. Davidson). New York: Brunner/ Mazel.Google Scholar
McLellan, A. T., Luborsky, L., Woody, G. E. & O'Brien, C. P. (1980) An improved diagnostic evaluation instrument for substance abuse patients, the Addiction Severity Index. Journal of Nervous and Mental Disease, 168, 26–33.CrossRefGoogle Scholar
Orford, J., Oppenheimer, E. & Edwards, G. (1976) Abstinence or control: the outcome for excessive drinkers two years after consultation. Behavioral Research and Therapy, 14, 409–418.CrossRefGoogle ScholarPubMed
Polich, J. M., Armor, D. J. & Braiker, H. B. (1981) The Course of Alcoholism: Four Years after Treatment. New York: Wiley.Google Scholar
Rounsaville, B. J., Kosten, T. R., Fish, G., Williams, J. B. W. & Spitzer, R. L. (1987) A field trial of DSM-III-R substance dependence disorders. American Journal of Psychiatry (in press).Google Scholar
Rounsaville, B. J., Kosten, T. R., Fish, G., Williams, J. B. W., Spitzer, R. L., & Williams, J. B. W. (1986) Proposed changes in DSM-III substance use disorders: description and rationale. American Journal of Psychiatry, 143, 436–468.Google Scholar
Simpson, D. D. & Sells, S. B. (1974) Patterns of multiple drug abuse: 1969–1971. International Journal of Addictions, 9, 301–314.Google Scholar
Skinner, H. A. & Allen, B. A. (1982) Alcohol dependence syndrome: measurement and validation. Journal of Abnormal Psychology, 91, 199–209.Google Scholar
Spitzer, R. L. & Williams, J. B. W. (1985) Structured Clinical Interview for DSM-III Patient Version, 7/1/85. New York: New York State Psychiatric Institute (Biometric Research Department).Google Scholar
Stockwell, T. R., Hodgson, R. J., Edwards, G., Taylor, C. & Rankin, H. J. (1979) The development of a questionnaire to measure severity of alcohol dependence. British Journal of Addictions, 74, 79–87.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.