Defining Substance Use Disorders: Do We Really Need More Than Heavy Use?

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  1. J. Rehm1,2,3,4,5,*,
  2. S. Marmet6,
  3. P. Anderson7,8,
  4. A. Gual9,
  5. L. Kraus10,11,
  6. D.J. Nutt12,
  7. R. Room11,13,14,
  8. A.V. Samokhvalov2,5,
  9. E. Scafato15,
  10. M. Trapencieris16,
  11. R.W. Wiers17 and
  12. G. Gmel2,6,18,19
  1. 1Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden Germany
  2. 2Centre for Addiction and Mental Health (CAMH), Toronto, Canada
  3. 3Institute of Medical Science, University of Toronto, Toronto, Canada
  4. 4Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada
  5. 5Department of Psychiatry, University of Toronto, Toronto, Canada
  6. 6Addiction Switzerland, Lausanne, Switzerland
  7. 7Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
  8. 8Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
  9. 9Addictions Unit, Psychiatry Department, Neurosciences institute, Hospital Clínic, IDIBAPS, Barcelona, Spain
  10. 10IFT Institut für Therapieforschung, Munich, Germany
  11. 11Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
  12. 12Centre for Neuropsychopharmacology, Imperial College London, London, UK
  13. 13Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
  14. 14Centre for Alcohol Policy Research, Turning Point Alcohol & Drug Centre, Fitzroy, VIC, Australia
  15. 15Population's Health and Health Determinants Units, National Observatory on Alcohol – CNESPS, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanita, Rome, Italy
  16. 16Institute of Philosophy and Sociology, University of Latvia, Riga, Latvia
  17. 17Addiction, Development and Psychopathology (ADAPT) Lab, Psychology, University of Amsterdam, Amsterdam, The Netherlands
  18. 18University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
  19. 19Alcohol Treatment Center, Lausanne University Hospital, CH-1011 Lausanne, Switzerland
  1. *Corresponding author: E-mail: jtrehm{at}
  • Received April 27, 2013.
  • Revision requested June 3, 2013.
  • Revision received June 16, 2013.
  • Accepted July 10, 2013.


Aims: The aim of the study was to explore whether the concept of heavy substance use over time can be used as definition of substance use disorder. Methods: Narrative review. Results: Heavy use over time clearly underlies the neurobiological changes associated with current thinking of substance use disorders. In addition, there is evidence that heavy use over time can explain the majority of social problems and of burden of disease (morbidity and mortality). A definition of substance use disorders via heavy use over time would avoid some of the problems of current conceptualizations, for instance the cultural specificity of concepts such as loss of control. Finally, stressing the continuum of use may avoid the high level of stigmatization currently associated with substance use disorders. Conclusion: ‘Heavy substance use over time’ seems to be a definition of substance use disorders in line with results of basic research and epidemiology. Additionally, it reduces stigmatization. This approach should thus be further explored.

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