title: Should tolerance and withdrawal be required for substance dependence disorders?
abstract: Despite the historical importance of tolerance and withdrawal in the substance abuse nomenclature, empirical evaluations of tolerance and withdrawal relative to other, non-physical, dependence criteria have been infrequent. Based on data from 521 subjects from a newly completed survey evaluating proposed options for DSM-IV substance use disorders, we found, first, across classes of drugs, requiring tolerance or withdrawal had little effect on rates of dependence, as most subjects who met dependence criteria for each drug class also reported tolerance. Second, tolerance and withdrawal did not emerge as superior to the other dependence criteria on several indicators of concurrent and predictive validity, including severity.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519.
authors.forename: K M
authors.initials: KM
authors.lastname: Carroll
authors.forename: B J
authors.initials: BJ
authors.lastname: Rounsaville
authors.forename: K J
authors.initials: KJ
authors.lastname: Bryant
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000145:classification / Q000175:diagnosis / Q000534:rehabilitation*; D000553:Ambulatory Care; D003042:Cocaine; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000145:classification / Q000175:diagnosis / Q000534:rehabilitation; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs; D012307:Risk Factors; D012917:Social Adjustment; D016320:Substance Abuse Treatment Centers; D013375:Substance Withdrawal Syndrome / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D019966:Substance-Related Disorders / Q000145:classification / Q000175:diagnosis / Q000534:rehabilitation*
chemical_list: D013287:Illicit Drugs; D011619:Psychotropic Drugs; D003042:Cocaine