Commonalities and Differences Across Substance Use Disorders: Phenomenological and Epidemiological Aspects.
BACKGROUND
Although psychoactive substances vary in many ways, they have important commonalties, particularly in their ability to lead to an addiction syndrome. The field lacks an updated review of the commonalities and differences in the phenomenology of alcohol, cannabis, tobacco, stimulants, opioids, hallucinogens, sedatives/tranquilizers, and inhalants and their related substance use disorders (SUDs).


METHODS
DSM-IV and DSM-5 SUD diagnostic criteria were reviewed, as was evidence from recent epidemiological and clinical research: psychometric studies (test-retest reliability, latent trait analysis); physiological indicators (tolerance, withdrawal); prevalence and age of onset. Information was incorporated from previous reviews, PubMed and Scopus literature searches, and data from large U.S. national surveys.


RESULTS
Empirical evidence in the form of test-retest reliability and unidimensionality supports use of the same DSM-IV dependence or DSM-5 SUD diagnostic criteria across substances. For most substances, the criteria sets were generally most informative in general population samples at moderate-to-severe levels of SUD. Across substances, 2 criteria (tolerance and use in hazardous situations) were identified as functioning differently in population subgroups. Since substances have different pharmacological effects, withdrawal is assessed using substance-specific symptoms, while tolerance is not; issues remain with the assessment of tolerance. Alcohol, tobacco, and cannabis were consistently identified as the substances with earliest onset of use, highest prevalence of lifetime use, and highest prevalence of lifetime disorder.


CONCLUSIONS
Despite differences between psychoactive substances, the generic DSM criteria set appears equally applicable across substances. Additional studies of tolerance and hazardous use will be useful for future nosologies. Alcohol, cannabis, and tobacco are the substances with the greatest public health impact due to the high prevalence and early onset of their use, and the potential all 3 substances have to lead to addiction.
Department of Psychiatry, Columbia University, New York City, New York.|New York State Psychiatric Institute, New York City, New York.
Dvora
D
Shmulewitz
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York.
Emily R
ER
Greene
Department of Psychiatry, Columbia University, New York City, New York.|New York State Psychiatric Institute, New York City, New York.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York.
Deborah
D
Hasin
D017668:Age of Onset; D004361:Drug Tolerance; D006801:Humans; D015995:Prevalence; D011594:Psychometrics; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000494:pharmacology; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology*
D011619:Psychotropic Drugs
DSM; Item Response Theory; Phenomenology; Reliability; Substance Use Disorders