Talk:Substance dependence

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Shirderp, Victoriayi, Noragwam (article contribs). Peer reviewers: AilinKim, AnnChen17.

Add to Page

Substance dependence and Substance are a clearly defined in the DSM IV however, addiction is not a term commonly used within the framework of diagnoising an individual nor in measuring the severity of an individuals condition. Addiction could be charactorized by either of these sub catergories. Substance dependence or Substance abuse. While there is disagreement on which of these catorgoies is addiction, it is widely excepted in the recovery community that either may describe an "ADDICT" Habit, dependence, and addiction, are three very real things, that can occur simultaneously, but indeed they are different. Lumping them together merely muddies the perception of each of the conditions. The World Health Organization started this foolish endeavor, to make the term 'addiction' meet what the layman's term meant. The short story, we lost real medical definition, so we could have talk shows about people being 'addicted' to anything they wished to produce. There is *dire* need for the distinction between them. And, the public needs made aware of this.

75.33.52.79 (talk)

"Addict" is more of a term for those whom are addicted, or those who crave a drug, and will seek drugs, (drug seeking behavior), when they do not have any more to take, the same as any other addictive disease, and they could be said to have an addictive personality. However, some whom are on medications to stop long term chronic pain, etc, do not crave the drug, even while having withdrawal symptoms if the drug is stopped, and only take the drug to feel normal, and live without constant pain. There should always be a difference shown, even though there are still some hard-line physicians whom say everyone are addicts, when that is not so, as pain specialists/rehab physicians say differently. In other words, one can be substance dependent, (including the long term use of steroids), and not be an addict, but still need to be weaned off a medication if it is no longer needed. Ref: American Pain Foundation, American Chronic Pain Association, and The National Pain Foundation.Craxd (talk) 20:25, 28 January 2013 (UTC)

Citations

Several theories of drug addiction exist, some of the main ones are genetic predisposition, the self medication theory, and factors involved with social/economic development.

Epidemiological studies estimate that genetic factors account for 40-60% of the risk factors for alcoholism. Similar rates of heritability for other types of drug addiction have been indicated by other studies (Kendler, 1994). Knestler hypothesized in 1964 that a gene or group of genes might contribute to predisposition to addiction in several ways. For example, altered levels of a normal protein due to environmental factors could then change the structure or functioning of specific brain circuits during development. These altered brain circuits could change the susceptibility of an individual to an initial drug use experience. In support of this hypothesis, animal studies have shown that environmental factors such as stress can affect an animal's genotype (Knestler, 1996). The self-medication hypotheses espoused by both psychoanalysts and biological researchers, predicts that certain individuals abuse drugs in an attempt to self-medicate their unique and seemingly intolerable states of mind (Khantzian, 1985). The self medication theory has a long history. Freud in 1884, first raised this concept in noting the anti-depressing properties of cocaine. Stress has long been recognized as a major contributor for drug cravings and relapse and is therefore supportive of the self-medication theory. In line with this theory, a person's use of a particular drug of choice is not an accident, but rather it is chosen for its pharmacological affect in relieving stressful symptoms or unwanted feelings. Research has shown that people who survive disasters are prone to stress related disorders such as Post Trauma Stress Disorder (PTSD) and depression. People who experience major trauma in their life experiences may self-medicate with drugs or alcohol to relieve the symptoms of PTSD and depression (Vlahov, 2002).jnewguy

Kendler, K.S., et al., (1994). A twin family study of alcoholism in women. In: Am J. Psychiatry 151, (pp707-715).

Khantzian, E.J. (1985). The Self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. In: Am. L. Psychiatry 142: (pp. 1259-1264).

Knestler, E.J., Berhow, M.T. & Brodkin, E.S. (1996). Molecular mechanisms of drug addiction: adaptations in signal transduction pathways. In: Mol. Psychiatry 1, (pp. 190-199).

Vlahov, D., et al. (2002). Increased use of cigarettes, alcohol, and marijuana among Manhattan,

New York, residents after the September 11 terrorist attacks. American Journal of

Epidemiology 155(11): 988-996, (2002).

Is the editor posting these citations suggesting we add them? the text was copypasted so would have to be rewritten to avoid copyright violation, i believe.66.80.6.163 (talk) 16:46, 16 February 2011 (UTC)

Remove Nils Bejerot/Public Health

There is no reason to have such a long discussion of the theories of Nils Bejerot (he was influential in his time within Sweden, but not much elsewhere, and his theories are not well-regarded today). All this information is already on the Nils Bejerot page, and Bejerot is already mentioned earlier on the Substance dependence page. As the entire "Public Health" section is currently entirely about Bejerot, I propose to remove the entire Public Health section. Likiva (talk) 09:10, 29 April 2010 (UTC)

Bejerots have been portrayed as a propagandist giving the Swedish police munition in its lobbying campaigns for harsher drug policies (see "Zero Tolerance Wins the Argument?" by Lenke and Olsson in "European drug policies and enforcement" for an example) and it is a shame that he is quoted as an authority on wikipedia. I concur with the previous speaker. Remove the section. Steinberger (talk) 19:33, 29 April 2010 (UTC)

I brought the issue up in August last year. I think those opposed to removal have had ample opportunity to come up with a reason. Deleted. --GSchjetne (talk) 01:46, 12 July 2010 (UTC)

"List of countries by drugs consumption"

Should be created a list of countries by drugs consumption.--Nekrox (talk) 09:23, 11 January 2011 (UTC)

what's this rubbish!!!!!!!!!!! —Preceding unsigned comment added by 203.176.151.253 (talk) 08:14, 21 January 2011 (UTC)

References

what is with the long chinese character Digital object identifier? does that need to be visible?(mercurywoodrose)66.80.6.163 (talk) 16:49, 16 February 2011 (UTC)

Substance addictiveness chart

I believe that this chart is highly suspect. For Tobacco, it has 2.3, 2.6, and 3.0 as pleasure, psychological addictiveness, and physiological addictiveness respectively, but then the mean for those three is listed as 2.23! I went and looked at the source, and found that the physiological addictiveness for tobacco is cited as a mere 1.8! This seems to imply that people smoke for the pleasure, not because it's a habit they can't kick, which has been my impression from personal experience. I just wanted to point this out, as it seems to throw the validity of the whole study under question(Other studies I've seen rank nicotine as being almost as physiologically addictive(or more) as heroin). — Preceding unsigned comment added by 68.212.245.182 (talk) 16:26, 5 June 2011 (UTC)

I agree. It is also strange that they say Cannabis and LSD are physically addictive. They ascribe low numbers, suggesting that they cause minimal physiological dependence, but I have never heard of one person who is physically addicted to LSD or cannabis. I doubt it is even possible. What does it mean to say that LSD is a .3 on the scale if it doesnt happen at all. — Preceding unsigned comment added by 71.204.24.212 (talk) 15:59, 14 June 2012 (UTC)

It is incorrect to say that LSD and cannabis and not associated with physiological dependence. Physiological dependence is defined by the presence of tolerance and/or withdrawal. Both tolerance and withdrawal have been documented with cannabis dependent individuals. Tolerance also rapidly develops with LSD; however, there is not a withdrawal syndrome for LSD. — Preceding unsigned comment added by Kelseybananas (talk • contribs) 16:16, 19 July 2013 (UTC)

A common class of drugs that has been left out of this list is the steroids group. Corticosteroids like prednisolone, (Prednisone), taken for a week can cause withdrawal symptoms if stopped abruptly. There are several groups of steroids, and about all can cause severe reactions if suddenly stopped after they have been administered for a while, thus the patient must be weaned from the drug. There is no difference from these withdrawal symptoms than there are with narcotics, except that the symptoms may differ.Craxd (talk) 20:51, 28 January 2013 (UTC)

‘Substance’ use

The article’s use of ‘substance’ strikes me as bizarre
Does it represent denial that ethanol and nicotine are drugs?
Or generally muddled thinking about drugs by supposed authorities?
Or am I substance dependent, within the meaning intended by the article, because air and water are substances?
Laurel Bush (talk) 15:31, 16 August 2011 (UTC)

drug use make people think indepentenly and makes them what you say ' clam '.

'Substance' is the medical term. Paint thinner is a substance, but one would hardly consider it a drug. -Highspam (talk) 19:09, 8 February 2012 (UTC)

What evidence is there, that medical professionals use terms like substance abuse or substance dependence instead of drug abuse and drug addiction? If that is really how the speak and write, we should include some information about word usage. If not, we should move the article (back?) to Drug addiction. --Uncle Ed (talk) 15:23, 2 April 2013 (UTC)

Lead

I just added the "lead" clean-up template. Seems to me that the lead needs to be rewritten in the "Substance dependence is" format rather than just diving in to the DSMMD's non-use of the term "addiction". Unfortunately, I am a complete layman in this area, so cannot do it myself. – ukexpat (talk) 15:13, 17 August 2011 (UTC)

WP:NOADS

WP:NOADS

Add Recovery Sources for Treatment Seekers 24 Hour Addiction Helplines By State: Alabama (256) 399-0220 Arkansas (501) 205-1895 Connecticut (860) 812-4305 Florida (321) 369-9956 Idaho (208) 473-2918 Iowa (712) 266-3564 Louisiana (318) 935-6161 Massachusetts (413) 306-3232 Mississippi (417) 429-4943 Nebraska (402) 296-8256 New Jersey (856) 282-1120 North Carolina (252) 364-3119 Oklahoma (580) 352-3547 Rhode Island (401) 288-3581 Tennessee (615) 224-8063 Vermont (802) 428-4698 West Virginia (304) 945-0238 Alaska (800) 315-2391 California (619) 569-1716 Delaware (302) 294-0986 Georgia (678) 712-1869 Illinois (708) 248-8393 Kansas (785) 380-0230 Maine (207) 272-2285 Michigan (989) 607-5595 Missouri (816) 396-8714 Nevada (775) 473-9878 New Mexico (575) 541-3487 North Dakota (701) 484-0368 Oregon (541) 378-6675 South Carolina (803) 675-5067 Texas (956) 205-0280 Virginia (757) 337-2939 Wisconsin (920) 482-2915 Arizona (520) 979-3403 Colorado (970) 315-0226 District of Columbia (202) 509-9590 Hawaii (800) 315-2391 Indiana (812) 558-0063 Kentucky (502) 385-0557 Maryland (443) 219-0612 Minnesota (952) 223-1135 Montana (406) 545-2133 New Hampshire (603) 821-4064 New York (845) 247-5704 Ohio (740) 251-9016 Pennsylvania (267) 415-1524 South Dakota (605) 385-0105 Utah (801) 438-4160 Washington (425) 242-5130 Wyoming (307) 222-0334 — Preceding unsigned comment added by 75.121.88.78 (talk) 19:14, 24 October 2011 (UTC)

Esctacy/MDMA as sever addiction potential>

It seems there is some bias in the addictive potential section, with the opening paragraph stating that MDMA has can result in severe addiction but it the table below, it is claimed to be less addictive than the famously non-addictive cannabis. — Preceding unsigned comment added by 129.12.237.254 (talk) 19:48, 11 May 2013 (UTC)

Work of Carl Hart

I smell the work of carl hart has been greatly under emphasized when it comes to the evidence for chemical dependency. — Preceding unsigned comment added by Xyn1 (talk • contribs) 23:18, 7 November 2013 (UTC)

If you link the relevant research reviews that include the research you're talking about, those reviews satisfy MEDRS, and the content isn't WP:FRINGE, then it will probably be added. If it fails one or more of those policies, it may only be added to a limited extent, or not at all. Seppi333 (talk) 23:30, 7 November 2013 (UTC)

I've removed this along with a lot of other non-medical sources. Seppi333 (Insert 2¢) 13:09, 9 January 2014 (UTC)

"Defining terms" section

I came here via this WP:MED notification with regard to this article. Looking in the edit history of this article, I saw this removal; in my opinion, most of that material should be in this article, but should be summarized better and should go in the History section...per Wikipedia:MEDMOS#Sections. The current matter on definitions with regard to this topic, however, should have a Definitions section...which is done for other medical articles where the definition aspect is needed to better understand the subject. Flyer22 (talk) 06:00, 11 January 2014 (UTC)

I agree that it'd be useful to have a definition section; most of the content in that section was on past definitions, which would be more suitable for a history section. That's really the only reason I cut a lot of it out. Seppi333 (Insert 2¢) 06:25, 11 January 2014 (UTC)

Edit: There was 1 paragraph stating a definition given by a single researcher that needed to come out though. Seppi333 (Insert 2¢) 06:28, 11 January 2014 (UTC)

There appear to be a bunch of circular references of terms that do no not have the same meaning. Tolerance, dependance and addiction are not the same thing. Tolerance is strictly pharmacological. Dependance can be both pharmacological and psychological. Addiction is behavior. Cancer patients on fentanyl patches will become opioid tolerant. They may experience anxiety and withdrawal if not medicated correctly ibluding the treatment of both chronic and breakthrough pain. They are not, however, "addicted." Addiction is continuing an often uncontrollable destructive behavior despite adverse affects. Lumping addiction in with dependance is medically inaccurate. It's important for people seeking to understand palliative care to know the difference. --DHeyward (talk) 13:01, 4 February 2014 (UTC)

Article size

This article is way too large (82k). Let's break it up into separate articles or in a different way, reduce the size. --WikiTryHardDieHard (talk) 15:59, 8 May 2014 (UTC)

Agree, it could use some paring down. Also it touches on 12 step programs but not some of the new non 12 step recommendations that have a higher success rate. That seems to be very conspicuously lacking on wikipedia as a whole-- References to that type treatment and commentary about it and given the prevalence of it, it would seem to be something we should be doing, or am I just missing it in the mix? Ladymacbeth9 (talk) 20:45, 1 June 2014 (UTC)

FOSB etc.

While the FOSB stuff looks plausible, I think it's radically oversimplifying things to state that it is the mechanism of addiction, as if the matter was settled beyond doubt, and these massive text dumps go way beyond what's needed. At the moment, I think it can best be regarded as a hypothesis.

The current text dump and huge transcluded table, is way too large for the context, discounts all the other theories, and, I believe, doesn't meet the requitements of the WP:NPOV policy to balance and attribute statements. It's also been inserted into at least two other articles: sexual addiction and addiction.

What would make more sense, and would meet the WP:NPOV requirement, would be a statement on the lines of "Several researchers, most notably Dr. X and Professor Y, have put forward the hypothesis that ...", to then describe the theory briefly, and then point the reader at the FOSB article for more detail. -- The Anome (talk) 23:45, 9 September 2014 (UTC)

@The Anome: I didn't notice this earlier. I've corrected the poor summary in the lead you pointed out. If you know of any competing theories in molecular biology, I'd be okay with with making the changes you're proposing. Seppi333 (Insert 2¢ | Maintained) 03:26, 10 September 2014 (UTC)

Nevermind - I'm assuming we've resolved this. Seppi333 (Insert 2¢ | Maintained) 07:25, 2 November 2014 (UTC)

Article split into Drug dependence and Drug addiction

Addiction and dependence glossary
addiction – a biopsychosocial disorder characterized by persistent use of drugs (including alcohol) despite substantial harm and adverse consequences addictive drug – psychoactive substances that with repeated use are associated with significantly higher rates of substance use disorders, due in large part to the drug's effect on brain reward systems dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake) drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose drug withdrawal – symptoms that occur upon cessation of repeated drug use physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens) psychological dependence – dependence socially seen as being extremely mild compared to physical dependence (e.g., with enough willpower it could be overcome) reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them rewarding stimuli – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach sensitization – an amplified response to a stimulus resulting from repeated exposure to it substance use disorder – a condition in which the use of substances leads to clinically and functionally significant impairment or distress tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose

Notified WT:MED and WT:PHARM due to article importance status.

Of all the articles written on a dependence- or addiction-related phenomenon, this article is by far the most borked.

The current article title reflects both the DSM terminology for addiction and a synonym for drug dependence. Since this article is literally written (rather hapharzardly) about both drug addiction and drug dependence (both concepts redirect here), this is a rather significant disambiguation issue (dependence vs addiction) and an undue weight issue (toward the DSM's terminology in the article title). It's actually quite laughable that there isn't any coverage at all of the DSM model (or any other diagnostic model) outside the lead where it just describes their confused definition of "dependence".

The only solution I can think of to address both of these problems simultaneously is to split the article into two articles on the aforementioned distinct neuropsychological concepts covered in this one, then redirect this page to drug dependence.

I'm going to proceed with this at some point within the next 30 days; appropriately splitting the relevant content in the article to the two new articles will require a lot of work on my part. If anyone has any alternative solutions in mind, please let me know. For context, the article lead and the glossary to the right indicate what "dependence" and "addiction" actually refer to when not using the DSM's borked definition/model of the concepts. Seppi333 (Insert 2¢ | Maintained) 13:29, 8 January 2015 (UTC)

I agree that there are multiple and major issues with this article - basically it is very poorly written and structured. Drug/substance dependence covers both physical and psychological/behavioural dependence, so I am not convinced that we need to delete this article and redirect it to a separate 'drug dependence' and 'drug addiction' article. If we are to have a separate behavioural/psychological/drug addiction article then it should be a sub page of this articles using purely on psychological/reward seeking dependence. Addiction tends to mean behavioural/reward seeking dependence whereas dependence can mean psychological or physical dependence and dependence is the preferred scientific term so I think that we should stick with dependence rather than addiction for article name choices. You may view the DSM as confusing but your suggestions are also confusing perhaps more so, it is a confusing area.

So to summarise, I oppose your suggestion and I think that this article should be kept. If content is to be split out it should be split out into sub/daughter focused articles Physical dependence (this article already exists) and Drug addiction and defined in the first sentence as a form of reward seeking psychological dependence on psychoactive substances or such like.--WholeNewJourney (talk) 16:10, 8 January 2015 (UTC)

Another major reason I oppose this suggestion is lay society is unfortunately conditioned to think of alcohol as separate from drugs (drink and drugs for example), so replacing this article with a 'drug addiction' article is going to further that confusion. Most people don't equate alcohol dependence as drug addiction when it is. Substance dependence is a very awkward and confusing area of psychiatry and psychology, especially its various definitions and sub definitions.--WholeNewJourney (talk) 16:40, 8 January 2015 (UTC)

it might be best to have separate articles so readers understand the difference.--Ozzie10aaaa (talk) 17:53, 8 January 2015 (UTC)

@WholeNewJourney: It's not confusing to me at all... though I have spent a stupid amount of time reading lit reviews, writing ΔFosB, and rewriting addiction/dependence related articles/sections. In any event, psychological dependence purely represents negative reinforcement, so it doesn't involve reward; in contrast, positive reinforcement is purely addiction's territory. Dependence may be referred to as addiction due to the DSM and similar models. For the reverse, addiction isn't related to dependence by any model, so they're not freely interchangeable terms. "Addiction" only refers to compulsion toward a rewarding stimulus.

If you really think this article should remain, it should be confined to its correct scope (the diagnosis of [an amalgamation of] dependence/addiction within the context of the DSM's disease classification - note the D; this is a much smaller scope than that of the present article). Fortunately, there's been an out-of-place section at addiction - addiction#DSM classification - entirely on this scope that could be copied or moved here to retain it as a stub. The appropriate scope of this article is not the parent article of dependence and addiction topics.

I also don't think the DSM is confusing, I think it's stupid, and I'm not alone on that. The biomolecular mechanisms of addiction and dependence are not the same (read the review linked in citation #2 below for a primer). There are quite a few examples of drugs that induce addiction but not a dependence syndrome and vice versa as well (e.g., caffeine and... expand the reference list below, then read the quote). Seppi333 (Insert 2¢ | Maintained) 20:09, 8 January 2015 (UTC)

I think the caffeine example (above) is on the mark, I myself need soda or coffee all day( I therefore have a dependence, and im positively reinforced when I have coffee ), however if I needed to take caffeine in some pill form for some medical issue my "need" could not be classified as the same.--Ozzie10aaaa (talk) 22:21, 8 January 2015 (UTC)

It is not just the DSM that lumps behavioural addiction, physical dependence etc together. The ICD does as well. To delete this article is to say the entire of mainstream psychiatry the world over is wrong in how they classify substance dependence and a couple of Wikipedia editors are correct. I do not mind a separate more focused daughter article for drug addiction but we can't just delete this article. It would be like deleting the article schizophrenia and replacing it with an article on the positive symptoms of schizophrenia and the negative symptoms of schizophrenia. Here is how the ICD 10 defines substance dependence. Dependence syndrome: A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.--WholeNewJourney (talk) 00:24, 9 January 2015 (UTC)

As I just said before, if you wish, we can simply cover the diagnostics of drug addiction/dependence/whatever the blob of disease processes "substance dependence" collectively refers to nowadays (it's not 1 disease, as explained in the review below) in this article using addiction#DSM classification + any relevant diagnostics additions.

I'm well aware that the ICD does roughly the same things with their terminology as the DSM. In fact, I'm not aware of any diagnostic model that does not use this borked convention. These models do not have the power to define a disease state because they are not god; all hail His Noodliness. They don’t even identify something new; they describe something known to medical researchers for clinicians, since knowledge of pathology doesn’t accrue in a vacuum. The APA defers to medical researchers in cases like this because they don’t have a staff of all the world’s leading experts on hand. In this case, it's the people conducting this research I've been pointing out, as there is no "competing" biomolecular model for addiction.

Anyway MOS:MED#Diseases or disorders or syndromes is what defines the scope for these 3 articles; as this is a diagnostics page, it's a subtopic of the other 2 articles and so has a narrower scope. The HUGE scope of this article is 1 of my major problems with it - it's not a solution I'll accept. It's essentially NPOV for the diagnostic classification vs the actual disease(s) it's supposed to describe. The DAB issue is my other main problem with it. Moving/copying the content from addiction#DSM classification to this article while splitting all the content of this article to drug addiction/dependence satisfies MOS:MED's guidance on the scope of disease diagnostics and fixes the DAB problem. Seppi333 (Insert 2¢ | Maintained) 10:11, 9 January 2015 (UTC)

Edit: Copying the addiction#DSM classification material the 2 new drug dependence/addiction articles would be an appropriate start for their diagnostic sections. Seppi333 (Insert 2¢ | Maintained) 10:31, 9 January 2015 (UTC)

I agree with Seppi333 view, logic and objectivity seem to be clear on this--Ozzie10aaaa (talk) 11:33, 9 January 2015 (UTC)

The POV you seem to hold Seppi and what some reviews also discuss is a notable one regarding how this subject area should be categorised and I believe that it should be included in these articles. My problem is that a significant minority viewpoint is being given WP:UNDUEWEIGHT. This problems goes beyond simply how do we split and categorise content. The first paragraph should be entirely concentrating in how mainstream psychiatry categorises substance dependence and using DSM V and ICD 10 as references. Any controversy or dispute in the academic literature should feature later on in the lead and given less attention in the article body that the mainstream viewpoints. According to MEDMOS we would need to cover a lot more than just the diagnostics of a substance dependence.--WholeNewJourney (talk) 20:58, 10 January 2015 (UTC)

To clarify, when I talk about "The first paragraph should...." I am referring to the lead of this article.--WholeNewJourney (talk) 01:25, 11 January 2015 (UTC)

This subject is categorized as it's always been: an operant model of reinforcement; the research definitions of addiction and dependence have never changed; they've always represented measurable and precisely quantifiable pathologically positively and negatively reinforced behavior, respectively. These behaviors are the invariant disease states which characterize addiction and dependence (i.e., you can't just wake up one day and decide to "redefine" [reprogram an animal brain so that] "addiction" refers to another disease state) with metrics that can be used to examine effects/relationships involving behavioral plasticity as well as identify the state of addiction (dependence) when it arises. Diagnostic models, which have constantly changing definitions, have no capacity to be used in a research setting because they contain no metrics for quantifying and measuring the magnitude of disease-related phenomenon (e.g., self administration reinforcement schedules). Why? Because it is a diagnostic model made for clinicians. It really puzzles me as to why you think that "substance dependence" refers to a disease state when it is quite clearly a phrase which has been defined and redefined repeatedly.

If I'm somehow unaware of a second research model of pathological reinforcement - one on which "substance dependence" is based, provide a citation. If "substance dependence" uses the operant model as its research paradigm, its own evidence refutes its validity since that evidence indicates negative reinforcement and positive reinforcement have distinct induction mechanisms (i.e., dependence and addiction have no commonality), as I've been saying is the case repeatedly. If you don't understand why the operant model isn't a diagnostic model, the reason is that it's way too technical/elaborate to be used in a clinical setting. I gather you don't understand that the operant model simply provides evidence-based research on addiction to mental health diagnostics entities with guidance/data on improving the clinical identification of the associated operant model disease states. If a diagnostic model isn't based upon a research model, it's completely vacuous because it has no evidence base.

The "significant minority viewpoint" statement amuses me. As opposed to "mainstream psychiatry", the current/uncontested model of addiction pathology spans "mainstream molecular biology" (the mechanism involves signaling cascades in accumbal dendrites and the ensuing transcription events), "mainstream psychology" (this whole thing is based on the operant model, which has never changed), "mainstream neurology" (this model examines brain structure, neural pathways, and normal vs pathological neurotransmission), "mainstream pharmacology" (obvious), and even "mainstream genetic engineering" (e.g., viral vector gene transfer of ΔJunD or ΔFosB to the nucleus accumbens via the adeno associated virus is employed almost always in primary research - accumbal ΔFosB overexpression is the sole requirement for inducing a generic addiction). Now, I wonder, which of these two models would appear to constitute a broader scope or more multidisciplinary viewpoint?

Anyway, either provide a citation on a second research model for these diagnostic models or stop arguing in this thread that diagnostic models should be on par with the operant research model. It's a ridiculous/nonsensical notion that these are the same for reasons I've stated above. Seppi333 (Insert 2¢ | Maintained) 07:31, 11 January 2015 (UTC)

It is clear that you are very intelligent and well read in this subject area (more so than myself) and I do not doubt that you have a good grasp of the research. I was just saying that DSM V and ICD 10 should be given more weight even if you don't agree with them for NPOV.--WholeNewJourney (talk) 11:10, 11 January 2015 (UTC)

Restructuring plan

@WholeNewJourney: Going forward, I think it would be best to include the material I mentioned above in this article as well as a section on epidemiology, management, and history/society/culture since these are more related to the diagnostic models than the particular disease states. I'll probably end up transcluding some of this article into the 2 new articles (drug addiction/drug dependence) to cover diagnostics for those disease states. I'm going to split anything from this article which is not about the diagnostics of addiction or dependence and I'm going to make clear in the lead that substance dependence is a nonspecific blanket diagnosis for a dependence-withdrawal syndrome or an addiction.

I intend to leave this article with the layout as follows:

• DSM classification - no change
• Risk factors - excluding "Dependence potential" and "Capture rates" which I'd move to drug dependence)
• Mechanisms - replacing everything with a summary of dependence mechanisms and addiction mechanisms in different subsections (per WP:SUMMARYSTYLE) and linking to the main sections in those articles with a {{main section}} hatnote)
• Management - pruning this section per WP:MEDRS when I do the split... it will probably shrink a lot
• History - no change
• Society and culture - no change
• See also
• Refs
• Ext links

So... besides those 3 sections (Risk factors, Mechanism, and Management), no other parts of this article are going to be split out or pruned. How do you feel about this? Seppi333 (Insert 2¢ | Maintained) 02:18, 31 January 2015 (UTC)

In case you care to read the refs
References

Nevermind, I ended up just merging "drug addiction" content to addiction. Keeping the 2 dependence topics together here and addiction topics over there at least makes the scope of the articles reflect the titles now. Seppi333 (Insert 2¢ | Maintained) 07:10, 12 February 2015 (UTC)

Merge discussion

difference or merged

Substance_use_disorder= substance dependence??
"In the previous diagnosis manual DSM-IV, substance use disorders were diagnosed as substance abuse or substance dependence.[4] However, in DSM-5 these diagnoses are replaced with "substance use disorder".[5][6]"
and Substance_abuse will be merged with substance use disorder
Vatadoshu (talk) 09:42, 28 February 2015 (UTC)

Merger proposal

I propose that "Substance-related disorder" be merged into "Substance dependence".

For Checkwiki, I just finished cleaning up several interwiki links that were specified in "Substance-related disorder". I tried to add these interwiki links to WikiData for "Substance-related disorder", but every interwiki link failed because they had already been properly specified in WikiData for "Substance dependence". Clearly, "Substance dependence" is being conscientiously maintained; "Substance-related disorder" is not.

Another example: "Substance-related disorder" has a "This page is a new unreviewed article" template at the top of the page. I have no idea why.

Another example: Both articles contain the same image--"Development of a rational scale to assess the harm of drugs of potential misuse (physical harm and dependence, NA free means).svg"

Knife-in-the-drawer (talk) 06:45, 18 April 2015 (UTC)

There are several closely related articles that could probably be combined including:

• Substance dependence
• Substance abuse
• Substance-related disorder
• Substance use disorder
• Substance intoxication
• Substance abuse prevention

These all have overlapping infobox identifiers. Sizeofint (talk) 18:10, 18 April 2015 (UTC)

That seems reasonable; I'll look into this and merge the articles that are more or less redundant diagnostic classifications sometime within the next few weeks. I have a lot on my editing plate at the moment. Seppi333 (Insert 2¢) 16:00, 22 April 2015 (UTC)

Excuse-me to not have following the talk. I am not often on wiki(en). Hope you will follow without me. Vatadoshu^french 14:22, 24 April 2015 (UTC)

It would be ideal to keep these topics on as few pages as possible to avoid redundancy. So, based upon the concept relationships to diagnostic models, the medical/operant concepts (addiction/dependence), and each other, I'd say:

• Move Substance dependence → Dependence or Stimulus dependence to generalize the concept. Would only need a copyedit to the lead following this change. We don't really cover things like exercise dependence/withdrawal – which is very common among amateur+professional athletes – or associated behavioral dependence-withdrawal syndromes anywhere AFAIK (excluding the cursory coverage of these concepts on psychological dependence).
• Merge the following articles into Substance-related disorder or Substance use disorder, due to these being the most general concepts among these
  • merge/redirect from Substance abuse (not even a medical concept)
  • merge/redirect from Substance use disorder (2nd most general term)
  • merge/redirect from Substance intoxication
  • merge/redirect from Substance abuse prevention (should've been a substance abuse subsection to being with)

I don't have time to go about merging all these though, since I still need to finish writing a GA that's been on hold for a while... Seppi333 (Insert 2¢) 13:01, 22 May 2015 (UTC)

Merge Substance intoxication and Substance abuse prevention into the Substance-related disorder article. I believe that substance dependence and Substance use disorder should be kept as separate articles as they are very substantial topics (with enormous amounts of research papers in the academic literature) that they deserve their own articles - the substance-related disorder article can contain short sections about substance dependence and substance use disorder which wiki link to the main articles.--WholeNewJourney (talk) 17:19, 23 May 2015 (UTC)

Alright, that sounds reasonable. Seppi333 (Insert 2¢) 23:58, 23 May 2015 (UTC)

Requested move 21 June 2015

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review. No further edits should be made to this section.

The result of the move request was: not moved. DrKiernan (talk) 20:09, 30 June 2015 (UTC)

---

Substance dependence → Dependence – Dependence redirects to the Dependency DAB page; the only 2 "Dependence" entries on the "Dependency" page are references to this topic: one relevant to non-drug stimuli, one relevant to drug stimuli. This page needs to be generalized to cover those 2 topics on 1 page, as the notion of dependence is not an exclusive characteristic of a substance. E.g., separation anxiety describes a form of non-drug dependence in which withdrawal is associated with removal of exposure to the stimuli of another individual. Another example is given above for exercise dependence. As there are no other "Dependence" entries on "Dependency", following this page move, there will be no ambiguity between the page title and the potential article scopes associated with the title. Seppi333 (Insert 2¢) 06:14, 21 June 2015 (UTC)

Addiction and dependence glossary
addiction – a biopsychosocial disorder characterized by persistent use of drugs (including alcohol) despite substantial harm and adverse consequences addictive drug – psychoactive substances that with repeated use are associated with significantly higher rates of substance use disorders, due in large part to the drug's effect on brain reward systems dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake) drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose drug withdrawal – symptoms that occur upon cessation of repeated drug use physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens) psychological dependence – dependence socially seen as being extremely mild compared to physical dependence (e.g., with enough willpower it could be overcome) reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them rewarding stimuli – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach sensitization – an amplified response to a stimulus resulting from repeated exposure to it substance use disorder – a condition in which the use of substances leads to clinically and functionally significant impairment or distress tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose

The only two outcomes of this requested move are that this page goes to one of the two following page titles:

1. Dependence
2. Stimulus dependence

For context, this topic is just as general as – and involves the mirror opposite form of (negative) reinforcement to that of – addiction. Seppi333 (Insert 2¢) 06:14, 21 June 2015 (UTC)

• support "dependence" better move--Ozzie10aaaa (talk) 11:23, 21 June 2015 (UTC)
• Comment: I don't seem to comprehend the reasoning behind this. You've just stated there are several types of dependence, including non substance-related. If so, moving Substance dependent to plain dependence doesn't make any sense according to your own words. You're implying to move a subtopic of dependence into an all-encompasing term. Best, FoCuSandLeArN (talk) 18:41, 21 June 2015 (UTC)
  • That's correct. There is no other dependence page at the moment - the other entry in the dependency DAB page is actually a redirect to an article which doesn't include any content on behavioral dependence. The article title needs to be generalized before including content on more general concepts though. I.e., I could add content on behavioral dependence right now using the pubmed references in the link above on exercise withdrawal, but it would be out of place given the current article title. The title needs to change first. Seppi333 (Insert 2¢) 21:33, 21 June 2015 (UTC)
• Oppose given how many non-redirect articles have dependence in their titles. Many of them have nothing to do with medicine. The disambiguation page is seriously incomplete. WhatamIdoing (talk) 03:15, 22 June 2015 (UTC)
  • touché Seppi333 (Insert 2¢) 03:52, 22 June 2015 (UTC)
  • @WhatamIdoing: Special:diff/668045004/668062674 - that a little better? Seppi333 (Insert 2¢) 05:39, 22 June 2015 (UTC)
    • Yes. NB that I love the idea of an article on the biopsychosocial(etc) subject of dependency (especially if it's written by you instead of someone like me. :-) I'm only objecting to the proposal to usurp a generic name that's used in so many unrelated disciplines (and in medicine for unrelated issues, like Dependent adults). WhatamIdoing (talk) 23:03, 23 June 2015 (UTC)
• Oppose - Agree with WAID. There's a lot of other articles with 'dependence' in their titles, and I don't think the meaning of 'dependence' lends itself naturally to mean 'substance dependence'. --Tom (LT) (talk) 00:24, 23 June 2015 (UTC)
• What about something like Dependence (psychology) if people are opposed to outright calling it Dependence. Sizeofint (talk) 06:14, 23 June 2015 (UTC)
• Strong oppose Wikipedia is not solely a medical encyclopedia. There are many forms of dependence having nothing to do with this topic. Financial dependence being the top of mind. -- 70.51.203.69 (talk) 11:26, 25 June 2015 (UTC)
• Oppose: Too ambiguous. —BarrelProof (talk) 09:11, 27 June 2015 (UTC)

---

The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page or in a move review. No further edits should be made to this section.

Risk Factors charts

The tables / charts in this section seem to distort that the information contained in them are the results of 1 study and not some sort of generally accepted information. Perhaps adding a citation to each cell or presenting the information in a normal paragraph would help... but I am not sure. Maybe find information from other studies.

The 2007 study is a bit dated. There are more recent analyses. Sizeofint (talk) 01:32, 22 November 2015 (UTC)

References

Plans to add to page

1. Under the "Society and Culture" section, we plan to add:

• a table of demographics displaying the prevalence of substance abuse in different countries.

2. Under the "Legislation" section, we plan to add:

• what the United States is doing to combat substance dependence, specifically about new policy proposals in California and Philadelphia regarding safe injection sites.
• what other countries like Canada are doing to combat substance dependence.
• edit the section to sound less opinionated and cite more reputable sources.
• proofread and restructure sentences to be more clear to the reader.

3. Under the "Treatment and issues" section, we plan to add:

• edit the references instead of having in-text citations.
• add information about naloxone.
• reorganize this section by creating more sub-sections.

4. Under "Alternative therapies" section, we plan to add:

• more alternative therapy options.

Victoriayi (talk) 00:48, 17 October 2018 (UTC)

Preliminary Edits to Treatment and issues

1. Added the Comer reference to the references list in order to cite it in-text; will work on researching the proper citation sources for the other works mentioned in the section currently and do the same with the rest.

2. Added sub-headings to separate into cognitive/behavioral and medicinal approaches; will add more medicinal approaches such as naloxone and naltrexone in the future.

3. Edited first two paragraphs to reflect a more unbiased wording (for example removed phrases such as "therefore psychologists should")

4. Added links to other Wikipedia articles, such as to Pavlov and Classical conditioning.

-Shirley Ng Shirderp (talk) 05:24, 30 October 2018 (UTC)

Preliminary Edits to Legislation Section

1. Added a section for the shift in legislation about drug abuse in the United States. 2. Planning on adding another section for another country. 3. Planning on editing citations to be uniform. — Preceding unsigned comment added by Victoriayi (talk • contribs) 06:52, 2 November 2018 (UTC)

Edits Made under Society and Culture

1. Added Demographics section

2. Added tables and supporting text on national demographics for the US

3. Briefly described demographics on a sub-regional level in US

4. Briefly mentioned demographics on a global level

-Nikki Oragwam--Noragwam (talk) 11:06, 2 November 2018 (UTC)

Does the draft submission reflect a neutral point of view? If not, specify…

This draft submission does seem to reflect a neutral point of view. The demographics data pulled from SAMHSA are reputable and provide important background information regarding the prevalence of substance dependence. However, in the US legislation section, there is a comprehensive background on regulation, but the only legislation that is cited is in CA - to ensure a broader scope of information, perhaps legislation in those other 9 states could be mentioned. Information presented about acupuncture as an alternative therapy provides balanced information in its role in treating substance dependence. Spang11 (talk) 07:38, 7 November 2018 (UTC)

Neutrality is present throughout the article. The edits proposed are also cited properly and don't reflect the author's viewpoints on any type or treatment of substance dependence. For example the demographics table and discussion on demographics is pulled from the national substance abuse and mental health services administration and very objective. Edits provided by Noragwam There is no opinion present about treatment of substance abuse and alternatives such as acupuncture provided by spang11 reflected empirical treatments with sources well cited.

ChristopherOng (talk) 17:37, 8 November 2018 (UTC)

Is there any evidence of plagiarism or copyright violation?

I did not detect any evidence of plagiarism or copyright violation. The group did a good job of using their own words and cited all of the necessary statements.

Pharmacy9876 (talk) 23:05, 7 November 2018 (UTC)

There appears to be no evidence of plagiarism or copyright violation. All content added was verifiable through citations to reliable sources.

AnnChen17 (talk) 17:41, 8 November 2018 (UTC)

Peer Review: Validity of sources

I reviewed some of the recent additions. Looking at the "Legislation" portion, there should be some sources in order to support the text. Under the demographic subheading, the sources are from reputable sources, relatively recent, and is a good addition to the section. I am not super sure if it would be best to cite the "Our World in Data" source versus the original source that they got it from such as "Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD)" or "WHO" listed within their article. I see that there are still works in progress for the "Treatment and Issues" section, so I will not be redundant other than to possibly remove the parenthetical citations in place of the traditional cite notes. Allison Nguyen (talk) 00:54, 8 November 2018 (UTC)

The table added to the Demographics section under "Society and culture" adds valuable data from the study done by Substance Abuse and Mental Health Services Administration. However, the citation should include a link that directs the user to the survey results. AilinKim (talk) 17:47, 8 November 2018 (UTC)

Are the edits formatted consistent with Wikipedia’s manual of style?

Testing