Defining Substance Use Disorders: Is Heavy Use Enough?
Defining Substance Use Disorders: Is Heavy Use Enough?
We have given evidence to redefine the concept of substance use disorders in terms of heavy use over time. Such a concept would incorporate all the necessary elements for decisions on prevention and treatment, and it would avoid culturally relative arbitrary definitions in terms of loss of control or of failure to fulfil social roles. It seems we do not need any other construct to describe the phenomenon of heavy use over time, such as the term addiction. Establishing heavy use over time as the relevant entity may also contribute to a de-stigmatization of people who use psychoactive substances heavily. It would also help to initiate lifestyle changes and treatment and other interventions for heavy use earlier in time, e.g. with brief interventions in primary health care (e.g. Kaner et al., 2007, for alcohol; Humeniuk et al., 2012, for illicit drugs; Doran et al., 2006, for tobacco). It may also help to close the treatment gap for substance use disorders by lowering stigmatization, especially for alcohol (Rehm et al., 2013).
Conclusions
We have given evidence to redefine the concept of substance use disorders in terms of heavy use over time. Such a concept would incorporate all the necessary elements for decisions on prevention and treatment, and it would avoid culturally relative arbitrary definitions in terms of loss of control or of failure to fulfil social roles. It seems we do not need any other construct to describe the phenomenon of heavy use over time, such as the term addiction. Establishing heavy use over time as the relevant entity may also contribute to a de-stigmatization of people who use psychoactive substances heavily. It would also help to initiate lifestyle changes and treatment and other interventions for heavy use earlier in time, e.g. with brief interventions in primary health care (e.g. Kaner et al., 2007, for alcohol; Humeniuk et al., 2012, for illicit drugs; Doran et al., 2006, for tobacco). It may also help to close the treatment gap for substance use disorders by lowering stigmatization, especially for alcohol (Rehm et al., 2013).
