Defining substance use disorders: do we really need more than heavy use?
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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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Heavy use is responsible for similar consequences (e.g., health, social) as dependence.
“We included DSMdefined outcomes (e.g., SUDs, alcohol use disorder) and heavy use, because heavy use is responsible for similar consequences (e.g., health, social) as dependence.16”
From Childhood Psychiatric Disorders as Risk Factor for Subsequent Substance Abuse: A Meta-Analysis. (2017) · cites this paper as [16]
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Hanschmidt, F., Manthey, J., Kraus, L., Scafato, E., Gual, A., Grimm, C., & Rehm, J. (2017) · Alcohol and Alcoholism · doi:10.1093/alcalc/agx032 · Cited by 34 · see citing works
Self-citationRehm, J., & Room, R. (2017) · Nordic Studies on Alcohol and Drugs · doi:10.1177/1455072517704795 · Cited by 31 · see citing works
Self-citationRethinking Unhealthy Alcohol Use in the United States: A Structured Review
Volpicelli, J. R., & Menzies, P. (2022) · Substance Abuse: Research and Treatment · doi:10.1177/11782218221111832 · Cited by 20 · see citing works
Moldekleiv, C. D., Lundervold, A. J., Solberg, B. S., Engeland, A., Fadnes, L. T., Chalabianloo, F., & Klungsøyr, K. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07305-1 · Cited by 8 · see citing works
- Authors
- Rehm, J., Marmet, S., Anderson, P., Gual, A., Kraus, L., Nutt, D. J., Room, R., Samokhvalov, A. V., Scafato, E., Trapencieris, M., Wiers, R. W., & Gmel, G.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- Addiction Switzerland (CH)
- Maastricht University (NL)
- Hospital Clínic de Barcelona (ES)
- Stockholm University (SE)
- Imperial College London (GB)
- Istituto Superiore di Sanità (IT)
- University of Latvia (LV)
- University of Amsterdam (NL)
- Corresponding author
- Rehm, J.
- ORCID
- Venue
- Alcohol and Alcoholism
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-08-07
- Volume
- 48
- Issue
- 6
- Pages
- 633-640
- ISSN
- 0735-0414 (ISSN-L)
- 1464-3502
- OpenAlex
- W2124390845
- Cited by
- 242
- References
- 93
- Citations by year
- 2026: 11 · 2025: 14 · 2024: 12 · 2023: 17 · 2022: 19 · 2021: 27 · 2020: 20 · 2019: 18 · 2018: 15 · 2017: 29 · 2016: 21 · 2015: 19 · 2014: 13 · 2013: 7
- FWCI
- 2.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alcohol and Alcoholism (publishedVersion)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion)
- SERVAL (Université de Lausanne) (publishedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- IRIS (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- European Commission (266813)
- Medical Research Council (G1002226)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- substance use disorders, loss of control, cultural specificity, stigmatization, neurobiological changes, disease burden, social problems
- MeSH terms
- Humans, Terminology as Topic, Substance-Related Disorders
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