Substance abuse versus dependence and the structure of common mental disorders

Abstract

Background In 1999, using data from the National Comorbidity Survey (NCS), Krueger presented a model that gave a novel taxonomic approach to mental disorders and their core psychopathologies. He proposed that the relationships among 10 common mental disorders could be understood in a factor structure composed of higher-order “Internalizing” and “Externalizing” factors, with the Internalizing factor subdivided into an “Anxious-Misery” subfactor and a “Fear” subfactor. However, Krueger did not include all of the mental disorders assessed in the NCS. The objective of the current study was to examine how alcohol abuse and drug abuse compare to alcohol dependence and drug dependence in Krueger's model. Method The sample for this research was the 8098 noninstitutionalized US civilians aged 15 to 54 years who participated in the NCS between 1990 and 1992. The data from the NCS were analyzed using confirmatory factor analyses. Results Alcohol abuse and drug abuse loaded on both the Anxious-Misery subfactor and the Externalizing factor and were distinct from alcohol dependence and drug dependence. Conclusions Individuals with drug abuse and alcohol abuse constitute a different population than individuals with drug dependence and alcohol dependence and have a different pattern of comorbidities. This suggests that underlying etiologies may vary between these 2 groups, leading to different approaches for both research and treatment.