Dematteis Maurice, Pennel Lucie, Brousse Georges
CHU Grenoble Alpes, service universitaire de pharmacoaddictologie ; université Grenoble Alpes, UFR de médecine, Grenoble, France.
CHU de Clermont-Ferrand, service de psychiatrieaddictologie B ; université Clermont- Auvergne-1, UFR de médecine, EA7280, Clermont-Ferrand, France.
Rev Prat. 2019 Oct;69(8):892-896.
Alcohol use disorder: evolution of the nosography. The arrival of DSM-5 has represented a nosographic break with respect to the DSMIV- TR: by leaving the old biaxial view and its hierarchical gradation between abuse and dependence; by removing the term "dependence" with its stigma and amalgams between psychic and physical dependencies; and by integrating craving, a main therapeutic target, allowing the DSM-5 to join the ICD-10 (and soon the ICD-11). Without being a revolution, the DSM-5 is a real evolution, with a modern dimensional view of addictive behaviors, according to a progressive continuum between use and use disorder (from mild to severe). This approach allows the representation of addictions to change, and to propose various therapeutic strategies adapted to the patient's objectives and inspired by the harm reduction approaches, abstinence being only one of these strategies.
疾病分类学的演变。《精神疾病诊断与统计手册》第五版（DSM-5）的出现代表了相对于《精神疾病诊断与统计手册》第四版修订本（DSM-IV-TR）在疾病分类学上的突破：摒弃了旧的双轴观点及其在滥用和依赖之间的层级划分；去除了带有污名化的“依赖”一词以及心理依赖和生理依赖之间的混淆概念；并纳入了渴望这一主要治疗靶点，使DSM-5与《国际疾病分类》第十版（ICD-10，很快还会与《国际疾病分类》第十一版（ICD-11）接轨）。DSM-5并非一场革命，而是一次真正的演变，它对成瘾行为采用了现代的维度视角，依据使用与使用障碍之间的渐进连续体（从轻度到重度）。这种方法使得成瘾的呈现方式得以改变，并能够提出各种适应患者目标且受减少伤害方法启发的治疗策略，禁欲只是其中一种策略。
