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Substance dependence and non‐dependence in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD): can an identical conceptualization be achieved?
Author(s) -
Saunders John B.
Publication year - 2006
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/j.1360-0443.2006.01589.x
Subject(s) - conceptualization , icd 10 , medical diagnosis , psychology , substance dependence , substance abuse , dsm 5 , nosology , chinese classification of mental disorders , psychiatry , construct (python library) , clinical psychology , substance use , addiction , medicine , personality disorders , social psychology , computer science , personality , artificial intelligence , pathology , sadistic personality disorder , programming language
Background This review summarizes the history of the development of diagnostic constructs that apply to repetitive substance use, and compares and contrasts the nature, psychometric performance and utility of the major diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) diagnostic systems. Methods The available literature was reviewed with a particular focus on diagnostic concepts that are relevant for clinical and epidemiological practice, and so that research questions could be generated that might inform the development of the next generation of DSM and ICD diagnoses. Results The substance dependence syndrome is a psychometrically robust and clinically useful construct, which applies to a range of psychoactive substances. The differences between the DSM fourth edition (DSM‐IV) and the ICD tenth edition (ICD‐10) versions are minimal and could be resolved. DSM‐IV substance abuse performs moderately well but, being defined essentially by social criteria, may be culture‐dependent. ICD‐10 harmful substance use performs poorly as a diagnostic entity. Conclusions There are good prospects for resolving many of the differences between the DSM and ICD systems. A new non‐dependence diagnosis is required. There would also be advantages in a subthreshold diagnosis of hazardous or risky substance use being incorporated into the two systems. Biomedical research can be drawn upon to define a psychophysiological ‘driving force’ which could underpin a broad spectrum of substance use disorders.