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Heroin Addiction and Related Clinical Problems: 2013, 15, 2 (pages: 7 - 18)

It's time to admit the existence of a psychopathology of addiction

Pani P. P., Maremmani A. G. I., Trogu E., Ruiz P., Akiskal H. S., and Maremmani I.

Summary: The frequency of the association between substance use and psychiatric disorders is higher than what might be expected as a result of chance alone; the most frequently associated psychiatric symptoms, syndromes and disorders pertain to the domains of mood, anxiety and impulsivity. There are several reasons for taking these psychiatric manifestations into account when evaluating clinical presentations of substance-use disorders. DSM nosology does not seem to grasp the complexity of the interaction between the psychic structures involved, and neurobiological and physiopathological processes activated by encounters with substances of abuse. Based on neurobiological, epidemiological and clinical indications, an integrated, unified perspective explaining the pathophysiology and phenomenology of addiction has been proposed. The lack of substantial changes in the approach to the psychiatric comorbidity of addiction in the DSM V, despite the plausibility of the hypothesis that there may be a close link between addiction and other specific psychiatric conditions, can be explained by the persistent insufficiency of aetiological and pathophysiological evidence which supports that kind of association. The validation of an articulated clinical condition, encompassing part of the grey area of symptomatology that exists between addiction itself and other ‘independent' psychopathologies, certainly calls for special attention and specific research programmes.