SUBSTANCE USE DISORDER - ABUSE, DEPENDENCE AND DYSCONTROL

The purpose of this paper is to review the diagnostic concepts of subs tance abuse and substance dependence provided in DSM-III, DSM-III-R, a nd the forthcoming DSM-IV. The review incorporates the principles that there are no infallible criteria for identifying when a person lacks sufficient control over the usage of a drug, that dyscontrol exists on a continuum, that substance use dyscontrol shares many formal propert ies with behavioral dyscontrol within other domains, and that the diag nosis of a mental disorder should be free of moralistic connotations. We conclude the paper with an alternative proposal, wherein the DSM-IV diagnoses of abuse and dependence are collapsed within one diagnosis of substance dyscontrol disorder and physiological substance dependenc e is placed with the diagnoses of substance intoxication and substance withdrawal.