Schuckit M A, Daeppen J B, Danko G P, Tripp M L, Smith T L, Li T K, Hesselbrock V M, Bucholz K K
Department of Psychiatry, University of California, San Diego, VA Medical Center, 92161-2002, USA.
Am J Psychiatry. 1999 Jan;156(1):41-9. doi: 10.1176/ajp.156.1.41.
The DSM-IV work group asked researchers and clinicians to subtype substance dependent individuals according to the presence or absence of physiological symptoms. A recent report from the Collaborative Study on the Genetics of Alcoholism demonstrated that among alcohol-dependent men and women, a history of tolerance or withdrawal was associated with a more severe clinical course, especially for individuals with histories of alcohol withdrawal. This article evaluates similar distinctions among subjects in the collaborative study who were dependent on marijuana, cocaine, amphetamines, or opiates.
Structured interviews gathered information from 1,457 individuals with a lifetime diagnosis of marijuana dependence, 1,262 with histories of cocaine dependence, 647 with amphetamine dependence, and 368 subjects with opiate dependence. For each drug, the clinical course was compared for subjects whose dependence included a history of withdrawal (group 1), those dependent on each drug who denied withdrawal but reported tolerance (group 2), and those who denied both tolerance and withdrawal (group 3).
The proportion of dependent individuals who denied tolerance or withdrawal (group 3) ranged from 30% for marijuana to 4% for opiates. For each substance, individuals in groups 1 and 2 evidenced more severe substance-related problems and at least a trend for greater intensities of exposure to the drug; those reporting withdrawal (group 1) showed the greatest intensity of problems.
The designation of dependence in the context of tolerance or withdrawal identifies individuals with more severe clinical histories. These results support the importance of the designation of a physiological component to dependence, especially for people who have experienced a withdrawal syndrome.
《精神疾病诊断与统计手册》第四版（DSM-IV）工作组要求研究人员和临床医生根据是否存在生理症状对物质依赖个体进行亚型分类。酒精中毒遗传学合作研究最近的一份报告表明，在酒精依赖的男性和女性中，耐受或戒断史与更严重的临床病程相关，尤其是对于有酒精戒断史的个体。本文评估了在该合作研究中依赖大麻、可卡因、苯丙胺或阿片类药物的受试者之间的类似差异。
通过结构化访谈收集了1457名终生诊断为大麻依赖的个体、1262名有可卡因依赖史的个体、647名有苯丙胺依赖史的个体以及368名阿片类药物依赖受试者的信息。对于每种药物，比较了依赖包括戒断史的受试者（第1组）、否认戒断但报告有耐受的每种药物依赖者（第2组）以及既否认耐受又否认戒断的受试者（第3组）的临床病程。
否认耐受或戒断的依赖个体比例（第3组）从大麻的30%到阿片类药物的4%不等。对于每种物质，第1组和第2组的个体表现出更严重的与物质相关的问题，并且至少有药物暴露强度更大的趋势；报告有戒断的个体（第1组）表现出最严重的问题强度。
在耐受或戒断背景下的依赖分类识别出有更严重临床病史的个体。这些结果支持了将生理成分纳入依赖分类的重要性，特别是对于经历过戒断综合征的人。
