Showing papers on "Substance abuse published in 1986"

Chronic use of opioid analgesics in non-malignant pain: Report of 38 cases

Abstract: Thirty-eight patients maintained on opioid analgesics for non-malignant pain were retrospectively evaluated to determine the indications, course, safety and efficacy of this therapy. Oxycodone was used by 12 patients, methadone by 7, and levorphanol by 5; others were treated with propoxyphene, meperidine, codeine, pentazocine, or some combination of these drugs. Nineteen patients were treated for four or more years at the time of evaluation, while 6 were maintained for more than 7 years. Two-thirds required less than 20 morphine equivalent mg/day and only 4 took more than 40 mg/day. Patients occasionally required escalation of dose and/or hospitalization for exacerbation of pain; doses usually returned to a stable baseline afterward. Twenty-four patients described partial but acceptable or fully adequate relief of pain, while 14 reported inadequate relief. No patient underwent a surgical procedure for pain management while receiving therapy. Few substantial gains in employment or social function could be attributed to the institution of opioid therapy. No toxicity was reported and management became a problem in only 2 patients, both with a history of prior drug abuse. A critical review of patient characteristics, including data from the 16 Personality Factor Questionnaire in 24 patients, the Minnesota Multiphasic Personality Inventory in 23, and detailed psychiatric evaluation in 6, failed to disclose psychological or social variables capable of explaining the success of long-term management. We conclude that opioid maintenance therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in those patients with intractable non-malignant pain and no history of drug abuse.

Acute cardiac events temporally related to cocaine abuse.

Abstract: The increasingly widespread use of cocaine in the United States has been accompanied and perhaps exacerbated by the misconception that the drug is not associated with serious medical complications. In particular, the potential for cocaine to precipitate life-threatening cardiac events needs to be reemphasized. We report the clinical and pathological findings in seven people in whom nonintravenous "recreational" use of cocaine was temporally related to acute myocardial infarction, ventricular tachycardia and fibrillation, myocarditis, sudden death, or a combination of these events. We also review data on 19 previously reported cases of cocaine-related cardiovascular disorders. Analysis of all 26 patients indicated the following findings: the cardiac consequences of cocaine abuse are not unique to parenteral use of the drug, since nearly all the patients took the drug intranasally; underlying heart disease is not a prerequisite for cocaine-related cardiac disorders; seizure activity, a well-documented noncardiac complication of cocaine abuse, is neither a prerequisite for, nor an accompanying feature of, cardiac toxicity of cocaine; and the cardiac consequences of cocaine are not limited to massive doses of the drug. Although the pathogenesis of cardiac toxicity of cocaine remains incompletely defined, available circumstantial evidence suggests that cocaine has medical consequences that are equal in importance to its well-documented psychosocial consequences.

Risk factors for drug use among adolescents: concurrent and longitudinal analyses.

Abstract: We examined the concurrent and longitudinal associations between risk factors and substance use for a sample of high school students. Ten risk factors were defined that assessed numerous important personal and social areas of life. These factors were found to be associated with ever using, frequency of use, and heavy use of cigarettes, alcohol, cannabis, and hard drugs. Few effects were noted for nonprescription medication. No sex differences were evident for number of risk factors. Finally, the number of different risk factors was predictive of increases in use of all types of substances over a one-year period, after controlling for initial level of use.

Psychiatric disorders in the biological and adoptive families of adopted individuals with affective disorders.

Abstract: • To investigate the contribution of genetic and environmental factors in the etiology of mood disorders, a study was initiated to examine the frequency of psychiatric disorders in the biological and adoptive relatives of adult adoptees with mood disorders and in matched normal adoptees. Psychiatric evaluations of the relatives were made on the basis of independent blind diagnoses based on mental hospital and other official records. Analysis of the data showed an eightfold increase in unipolar depression among the biological relatives of the index cases and a 15-fold increase in suicide among the biological relatives of the index cases. These data demonstrate a significant genetic contribution to unipolar depression and suicide. They fail to disclose a significant contribution of family-associated transmission in the genesis of the mood disorders.

Depression, self-derogation, substance use, and suicide ideation: lack of purpose in life as a mediational factor

Abstract: A theoretical model of adolescent behavior is examined separately for males and females (N = 722). The model hypothesizes that depression and self-derogation may lead to a lack of purpose in life, which, in turn, may lead to suicide ideation and substance use. Confirmatory factor analyses and structural equation procedures were used to examine the model, using Bentler's (1984) EQS computer program, which is available from BMDP. For both the men and women, the model adequately accounted for the data although there were some important differences between the sexes. In response to psychic discomfort (i.e., Depression and Self-derogation), men are more apt to turn to drugs and alcohol, whereas women consider suicide. Conversely, the situation changes in response to feelings of meaninglessness or a lack of purpose in life. Here, the females appear to turn to substance use, whereas the males react with thoughts of suicide.

Drug use among American high school students, college students and other young adults: National trends through 1985

Abstract: Drug use and related attitudes of U.S. high school seniors from the graduating classes of 1975-1985 aad young adults is their late teens and earlyto mid-twenties were studied, as part of an ongoing research project. Eleven classes of drugs were assessed: marijuana (including hashish), inhalants, hallucinogens, cocaise, heroin, other natural and synthetic opiates, stimmlants (amphetamines), sedatives, tranquilizers, alcohol, and cigarettes. Several subclasses of drugs were also covered: PCP and lysergic acid diethylamide (LSD), amyl and butyl nitrites, and barbiturates and methaqualone. Attention was focused on drug use at the higher frequency levels rather than whether respoadents had ever used various drugs. Of concern were: age of first use; the seniors' own attitudes and beliefs; and the attitudes, beliefs, and behaviors of others in the seniors' social environment, including perceived drug availability. The use of non-prescription stimulants, including diet pills, stay-awake pills, and pseudo-amphetamines were also reported, along with cocaine use among young people. Findings include sex differences in drug use, differences related to college plass, regional differences, and differences related to population deasity. The implications of findings for prevention efforts were addressed. (SW) ************** Reproduct ************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *** * * ** * ** * **** * *** * * ** * * * * ions supplied by EDRS are the best that can be made from the original document. ********************************************************* National Institutu on Drug Abuse DRUG USE AMONG AMERICAN HIGH SCHOOL STUDENTS, COLLEGE STUDENTS, AND OTHER YOUNG ADULTS National Trends through 1985 U.S. DEPARTMENT OF EDUCATION Office of Educational Ruesrch and Improvement ED CATIONAL RESOURCES INFORMATION CENTER (ERIC) This document heti been reproduced as received from the person Of ozganizahon originating it O Minor changes have been made to improve reproduction quality Points ol view or opinions stated in this docu. ment do not necessarily represent official OERI position or policy LC.) \`) U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service *C3 Alcohol, Drug Abuse, and Mental Health Administration DRUG USE AMONG AMERICAN HIGH SCHOOL STUDENTS, COLLEGE STUDENTS, AND OTHER YOUNG ADULTS National Trends through 1985 by Lloyd D. Johnston, Ph.D. Patrick M. O'Malley, Ph.D. Jerald G. Bachman, Ph.D. The University of Michigan lnsfitute for Social Research Natkmal Institute on Drug Abuse 5600 Fishers Lane Rockville, Maryland 20857 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration

An Adoption Study of Genetic and Environmental Factors in Drug Abuse

Abstract: • In a sample of 242 male and 201 female adoptees who had been separated at birth from biologic parents, adult adoptee diagnoses of alcohol abuse, drug abuse and antisocial personality were correlated with biologic and environmental factors. Three etiologic relationships with drug abuse were found: (1) drug abuse was highly correlated with antisocial personality, which in turn was predicted from antisocial biologic background; (2) a biologic background of alcohol problems predicted increased drug abuse in adoptees who did not have antisocial personalities; and (3) environmental factors of divorce and psychiatric disturbance in the adoptive family were associated with increased drug abuse.

The Impulsivist: a multi‐impulsive personality disorder

Abstract: Summary The authors report a literature review of impulsivity in the substance abuse disorders, eating disorders, classical disorders of impulse control, self-harm and personality disorders. They suggest that within each of these clinic populations there is a significant number of patients who have a very poor prognosis and are characterised not just by the specific presenting symptom but by multiple impulsive behaviours. It is suggested that this group, who place very large demands both on the psychiatric and emergency services, form a unitary ‘multi-impulsive personality’ group and that they would repay detailed research which cuts across the boundaries of the specialist services.

Alcoholism, Drug Abuse, and Gambling

Abstract: Patients in an alcoholism and drug dependency treatment facility were questioned about their gambling behavior in order to find out what percentage of them were abusing alcohol and/or drugs and gambling. In order to do this, a pathological gambling signs index was constructed according to a modification of DSM III criteria and validated using independent procedures. Out of 458 patients interviewed, 40 (9%) were diagnosed as pathological gamblers and an additional 47 (10%) showed signs of problematic gambling. These patients showed clear signs of emotional, financial, family and occupational disruption, and illegal behavior in connection with their gambling which compound the disruption induced by alcohol and/or drugs. Five per cent of the patients abusing only alcohol, 12% of those with alcohol and another drug in combination, and 18% of those with other drug abuse problems without an alcohol component showed clear signs of pathological gambling; 11 1/2% of males and 2% of females were classified as pathological gamblers. The index was also significantly associated with parental gambling (38% of the children of pathological gamblers were pathological gamblers themselves). Gambling by siblings, alcoholism in the father (but not in the mother), gambling prior to age 20, greater amounts of gambling for more money, and "chasing losses in order to get even" were also positively correlated with the index. The implications for study and treatment of these individuals are discussed in terms of the study of addictions.

Childhood predictors of adolescent substance abuse: Toward an empirically grounded theory.

Abstract: This article reviews the etiology of chemical use and abuse among children and adolescents as well as states the etiological pathways of youth drug behavior between initial, occasional and regular use. The authors also discuss determinants of the onset of chemical use such as the family; peers; early antisocial behavior; school; attitudes, beliefs and personality traits; and early initiation of use. They develop a theoretical premise based on the most current etiological research and offer a social development model that serves as a basis for prevention intervention.

Substance abuse prevention research: recent developments and future directions.

Abstract: Substance abuse continues to be one of the most serious problems facing communities throughout the United States. Existing school-based prevention programs have produced disappointing results when carefully evaluated. However, promising research has been conducted during the past eight years with two new prevention models that focus on the psychosocial factors believed to promote substance abuse. One, the social influence model, is designed to increase adolescents' ability to resist social influences to smoke, drink, or use drugs. The other model, though also designed to increase adolescents' resistance to pro-substance use social influences, focuses primary attention on the development of an array of cognitive-behavioral personal and social skills. More than 20 research studies testing programs based on these two prevention models have demonstrated significant reductions in substance use. Though future research is clearly needed, the results of these studies provide considerable cause for optimism.

A 2.5-year follow-up of depression, life crises, and treatment effects on abstinence among opioid addicts.

Abstract: • Follow-up studies have suggested that treatment increases addicts' likelihood of remaining abstinent and that depression and life crises are associated with decreased abstinence. An important issue is to what extent receiving treatment can ameliorate psychosocial risk factors such as life crises and depression and decrease ex-addicts' vulnerability to continued drug abuse. In our 2.5-year follow-up of 268 opiate addicts, drug abuse treatment was generally associated with increased abstinence, and life crises and depression were significant risk factors for continued drug abuse. The impact of these risk factors, however, was ameliorated by drug abuse treatment. Although life crises had a greater impact than depression, these two risk factors had additive effects in increasing the risk for continued drug abuse. Among the types of life crises, arguments and losses ("exits") had very strong additive effects with depression as predictors of drug abuse.

Outpatient treatment of patients with substance abuse and coexisting psychiatric disorders.

Abstract: Thirty-two patients with coexisting substance abuse and other psychiatric disorders were treated in a unique outpatient pilot program that used techniques drawn from both psychiatric and substance abuse treatment. Eleven patients remained in treatment for 3 or more months, and seven completed a year or more of treatment. Severity of associated psychiatric illness did not affect retention in treatment. Drug-abusing patients and those with personality disorders dropped out quickly; patients with a history of reliable outpatient treatment involvement tended to remain in treatment. Treatment retention was associated with reduced hospital utilization. The authors suggest guidelines for management of patients with coexisting substance abuse and other psychiatric disorders.

Suicidal thoughts and behaviours in former sexual abuse victims.

Abstract: The relationship between childhood sexual abuse and subsequent suicidality was examined in 195 women presenting to the Crisis Intervention program of a community health centre. As predicted, former sexual abuse victims were considerably more likely to have made at least one suicide attempt in the past (55%) than were non-abused clients (23%), and were more likely to report suicidal ideation upon intake. Rirther analysis revealed that sexual abuse was specifically associated with suicide attempts which occurred in childhood or adolescence. Among former sexual abuse victims, greater suicidality was correlated with multiple perpetrators, concurrent physical abuse, and sexual intercourse. Childhood sexual abuse is hypothesized to result in lowered self-esteem, guilt and self-blame, perceived powerlessness, and interpersonal dysfunction all of which may lead to increased selfdestructiveness. Clinical implications of these findings are discussed. Recent research on the incidence and effects of childhood sexual abuse challenges long-held assumptions and beliefs concerning sexual molestation. Current data suggests, for example, that approximately 1/5 to 1/3 of adult women have experienced sexual abuse during childhood or adolescence (Bagley & Ramsay, 1985; Briere & Runtz, 1985; Finkelhor, 1979; Russell, 1983), and that such victimization is often associated with enduring psychological dysfunction (see Browne & Finkelhor, 1986, for a review of these studies). Among other problems, long-term sequelae of sexual abuse appear to include depression, guilt, poor self-esteem, and feelings of inferiority (e.g., Brickman & Briere, 1984; Briere, 1984; Briere & Runtz, 1985; Herman, 1981; Jehu, Gazan, & Klassen, 1985; Meiselman, 1978; Peters, 1984; Tsai & Wagner, 1978), as well as interpersonal problems, delinquency, and substance abuse (e.g., Briere, 1984; Courtois, 1979; Herman, 1981; Tsai, Feldman-Summers, & Edgar, 1979; Benward & Densen-Gerber, 1975; Peters, 1984; Runtz & Briere, in press). Given such effects, it is probably not surprising that clinicians and researchers in this area cite self-destructiveness as a common problem among sexual abuse Portions of this paper were presented at the annuai meeting of the American Association of Suicidology, Toronto, 1985. The authors wish to thank the staff and management of Klinic, Inc., Community Health Centre, Winnipeg, Manitoba, for their support of this project. Thanks are also due Ms. April Lightfoot for her help as a research assistant. Address reprint requests and correspondence to John Briere, Ph.D., Dept. of Psychiatry, Building 1-South, Harbor-U.C.L. A. Medical Center, 1000 W. Carson St., Torrance, CA 90509. CANAD. J. BEHAV. SCI./REV. CANAD. SCI. COMP. 18(4), 1986

Prevalence of Alcohol and Other Drug Problems Among Physicians

Abstract: Extreme statements regarding the prevalence of problems with alcohol and other drugs among physicians have often been made without firm empirical support. The data that are available can be categorized as follows: license and disciplinary actions, known or registered addicts, mortality rates, hospital admissions and treatment populations, and surveys of selected groups of physicians. Because of difficulties in interpreting each type of data, it must be concluded that the prevalence of drug problems among physicians is unknown. A previously unpublished survey of Ontario physicians found that the proportion who have been treated for problems with alcohol and other drugs is not greater than that in the general population. Indeed, when alcohol and other drugs are considered together, physicians may not be unusually likely to have such problems. ( JAMA 1986;255:1913-1920)

Alcohol abuse, other drug abuse, and mental disorders in medical practice. Prevalence, costs, recognition, and treatment.

Abstract: Millions of Americans suffer and die of alcohol abuse, other drug abuse, and mental disorders that go undiagnosed and untreated. Studies showing that up to 19% of the US adult population have these disorders also have found that only one fifth of those affected have sought help for them in the previous six months. Many of these persons have disorders that are treatable with modern medications and therapy. Because more than half of all persons with these disorders obtain all of their care from the general medical sector, a great potential exists in primary care for prevention, detection, treatment, and referral of these patients. Primary care physicians, however, have not been very successful at diagnosing and treating substance abuse and mental disorders because of inadequate training, patients' attitudes, and the constraints of the health care system. Recommendations to improve this situation include continued research, improved physician education, and increased emphasis on care of these disorders by organized medicine. Although tobacco use is also a major health problem, data relating to nicotine addiction were not included in this report. ( JAMA 1986;255:2054-2057)

Psychopathology in chronic cocaine abusers.

Abstract: A group of 30 hospitalized cocaine abusers were studied, along with 124 hospitalized patients who were dependent upon opiates or central nervous system depressants. DSM-III diagnoses, family history data, demographic characteristics, and measures of current depressive symptomatology were compared in the two groups. Nineteen (63%) of the cocaine abusers met criteria for an Axis I diagnosis other than substance abuse; sixteen (53%) had affective disorder. These figures reflected a significantly higher prevalence rate of affective disorder among the cocaine abusers than among the opiate and depressant abusers. In addition, a significantly higher rate of affective disorder was found in the first degree relatives of the cocaine abusers when compared to the other group. Since these findings suggest that a substantial number of cocaine abusers may be suffering from other psychiatric disorders, careful diagnostic evaluation is indicated in this population.

Psychopathology and addictive disorders

Abstract: Dr. Meyer has gathered a distinguished group of academicians and clinicians who provide a comprehensive review of all the complex relationships between substance abuse and psychopathology. The recent escalation of research on the role of personality and psychopathology on addictive disorders and the understanding of the etiology, diagnosis, and treatment that the research has produced has been brought together in this timely contribution. PSYCHOPATHOLOGY AND ADDICTIVE DISORDERS is a landmark text in an area of increasing importance. It should be read by anyone who is interested in any aspect of the study or treatment of individuals with alcohol or drug problems.

San Diego Suicide Study. II. Substance abuse in young cases.

Abstract: • Fifty-three percent of 133 consecutive young suicides had a principal psychiatric diagnosis of substance abuse. Twentyfour percent had an additional principal diagnosis of atypical depression, atypical psychosis, or adjustment disorder with depression. The relationship of the substance abuse to the additional diagnosis was usually obscure, though this subgroup was similar to the group with only substance abuse on a number of factors. Typically, substance abuse was a chronic condition present for nine years. Multiple substance abuse was the norm in these cases, and marijuana, alcohol, and cocaine were the most frequently abused substances. Substance abusers without other principal diagnoses received psychiatric care less frequently than those with additional principal diagnoses.

Epidemiology of Drug Abuse: An Overview

Abstract: Issues regarding the use of epidemiology in drug abuse research are discussed and systems for monitoring national trends and identifying risk factors are described. Data indicate a general decline in marijuana use among youth, a cohort aging effect among heroin and marijuana users, and increased prevalence and health consequences associated with cocaine use.

Family-Oriented Interventions for the Prevention of Chemical Dependency in Children and Adolescents.

Abstract: Researchers and clinicians are begining to recognize the valuable resource that parents and families are for increasing the effectiveness of substance abuse prevention programs for youth and adolescents. To date, however, most prevention interventions have been developed for use in community or school-based programs. There is a growing number of family-oriented interventions which have been developed specifically as substance abuse prevention programs, or may be easily adapted for use by prevention specialists. This article will review these family-oriented interventions and discuss outcome effectiveness data when available.

Frequency and Sequence of Drug Use: A Longitudinal Study from Early Adolescence to Young Adulthood

Abstract: Although drug use has been found to be acquired in a series of stages or steps, the exact nature of this progression has not been firmly established, nor has such a process been corroborated for life periods other than adolescence. In this study, drug use data obtained from 654 adolescents were used to examine changes and sequencing of drug involvement over an eight-year period from early adolescence to young adulthood. Cannabis use peaked during late adolescence; liquor, stimulants, and nonprescription medication increased steadily over the eight-year period; hypnotics and psychedelic use increased through late adolescence and remained stable through young adulthood; and early experimental use of cigarettes decreased to more committed use over the eight-year span. In a latent variable model that did not include nonprescription drugs and cigarettes, alcohol use significantly influenced later cannabis and hard drug use, whereas cannabis use predicted later hard drug use for the earlier life period. Only th...

Psychoactive Drug Use among Practicing Physicians and Medical Students

Abstract: We surveyed random samples of 500 practicing physicians and 504 medical students in a New England state during 1984-1985; 70 percent of the physicians and 79 percent of the students responded. Fifty-nine percent of the physicians and 78 percent of the students reported that they had used psychoactive drugs at some time in their lives. In both groups, recreational use most often involved marijuana and cocaine, and self-treatment most often involved tranquilizers and opiates. In the previous year, 25 percent of the physicians had treated themselves with a psychoactive drug, and 10 percent had used one recreationally. Although most of the use was experimental or infrequent, 10 percent of the physicians reported current regular drug use (once a month or more often) and 3 percent had histories of drug dependence. More physicians and medical students had used psychoactive drugs at some time than had comparable samples of pharmacists and pharmacy students. The results suggest a need for renewed professional education about the risks of drug misuse.

Controlled prospective fifteen year follow-up of hyperactives as adults: non-medical drug and alcohol use and anti-social behaviour.

Abstract: This is a fifteen year prospective controlled study of the non-medical drug and alcohol use and antisocial behaviour of 61 hyperactives, and 41 matched control subjects, (mean age 25 years). The data was collected from detailed interviews with the subjects as well as computerized court records to verify subjects reports. Generally hyperactives did not differ significantly from controls on current drug and alcohol use and antisocial behaviour. However one sees trends of greater drug alcohol and antisocial involvement in the hyperactive group. All the subjects who have antisocial behaviour at 15 year follow-up (mean age 25) had early and persistent histories of antisocial behaviour beginning at initial assessment (mean age 8) or at 5 year follow-up (mean age 13). However many hyperactives do not continue their antisocial behaviour into adulthood (mean age 25). There thus appears to be a small subgroup of hyperactive subjects who have more negative outcomes with significantly greater social, emotional and psychological difficulties. It is this subgroup which we need to identify early and treat vigorously.

Lifetime psychopathology in individuals with low sexual desire.

Abstract: Lack of interest in sexual activity is one of the most prevalent psychosexual problems seen by clinicians. No consensus exists on etiology, symptomatology, appropriate therapeutic intervention, or prognosis. Desire disorders are believed to be highly refractory to treatment because of severe intrapsychic conflict, but no systematic data have been gathered about the histories of psychopathology in these individuals. Forty-six married subjects with a primary DSM-III diagnosis of global inhibited sexual desire (ISD) were compared with 36 matched controls on lifetime psychopathology, current psychological profiles, and premenstrual syndrome. A clinical interview, the Schedule for Affective Disorders and Schizophrenia-Lifetime Version and the SCL-90-R were administered to all subjects. Only ISD subjects free from any other axis I disorder, medical illness, medication use, or substance abuse were selected; controls met similar criteria but had no sexual dysfunction. Despite the fact that all ISD subjects had nearly normal psychological profiles at the time of assessment, more ISDs than controls had significantly elevated lifetime prevalence rates of affective disorder. The proportion of ISD individuals with histories of major and/ or intermittent depression alone was almost twice as high as controls. Additionally, the initial episode of the depressive disorder almost always coincided with or preceded ISD onset. Significantly more ISD women than controls also had severe symptoms of premenstrual syndrome. The remarkable lifetime rate of affective illness in ISD patients suggests that there may be a common biological etiology or that affective psychopathology may be contributing to the pathogenesis of the ISD dysfunction.

Maternal cocaine abuse and effect on the newborn.

Abstract: Cocaine has been increasingly available to a wider population of potential users in the United States. Information concerning possible effects of this agent on the fetus and newborn is lacking. We observed eight infants whose mother9s gave a history of cocaine abuse and, in whom, results of a urine screen for cocaine were positive. We observed no evident symptomatology or signs of teratogenicity on these infants. Although this is encouraging, more studies, including Brazelton assessment, and long-term follow-up of infants born to cocaine-abusing mothers is necessary.

Family Environmental and Genetic Influences on Children's Future Chemical Dependency

Abstract: This article reviews possible genetic and environmental factors which contribute to future chemical dependency in children of aicohol and drug abusing parents. Studies on genetic vulnerability and biological markers of alcoholism and drug abuse are reviewed. Recent studies by the authors on characteristics of families with chemically dependent parents and the affective, cognitive, and behavioral impacts on the children are discussed. The conclusion includes recommendations concerning the need for more family-focused prevention interventions for children of chemically dependent parents.

Proposed changes in DSM-III substance use disorders: Description and rationale.

Abstract: The authors describe changes in DSM-III substance use disorders to be included in the revised version, DSM-III-R. Major revisions include removal of the distinction between "abuse" and "dependence" and broadening the definition of "dependence" to a syndrome of clinically significant behaviors that indicate a serious degree of involvement with psychoactive drugs; creation of a new category of "psychoactive substance neuroadaptation syndrome" for individuals whose physiological adaptations to high doses of psychoactive substances did not arise from their own behavior; use of an identical set of symptoms and behaviors to determine dependence on all different classes of psychoactive substances; and provision of a system for rating severity of dependence.