Transitioning from DSM-IV Abuse to Dependence: The Essence of Harmful Compulsive Substance Use is Ontogenetic and Dynamic

Abstract

Florez-Salamanca and colleagues’ study1 of transitioning from DSM-IV substance abuse to dependence in this issue of The American Journal of Drug and Alcohol Abuse is important, in part, because the topic represents the juncture of several contemporary unresolved issues that are critical to healthcare. Harmful compulsive substance use, termed substance use disorder (SUD) in Diagnostic and Statistical Manuals (DSM), is among the most prevalent medical conditions. Lifetime DSM-IV SUD prevalence in the U.S. consequent to habitual use of tobacco, alcohol and illegal drugs, respectively, is 24%, 20% and 10%.2–4 Globally, smoking is the 4th leading contributor to disease burden, alcoholism is the 5th leading cause and illegal drug use is the 15th.5In the U.S. alone, harmful substance use costs the nation well over $400 billion annually6 due to consequences such as SUD treatment, crime, traffic accidents, medical and psychiatric disorder, domestic violence, child abuse/neglect, underemployment and job-related injury, suicide, traumatic injuries, and sexually transmitted disease including HIV/AIDS. Thus, research on SUD etiology and developmental transitions has tremendous potential to benefit at-risk individuals, their families and society.