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July 22, 1988

Substance Abuse Terminology

Author Affiliations

Los Angeles

Los Angeles

JAMA. 1988;260(4):477-478. doi:10.1001/jama.1988.03410040049022

To the Editor.—  I applaud the effort that has gone into the process of trying to arrive at a consensus on the definition of terms in the field of chemical dependency.1 In many respects the project has been successful. However, there remains confusion about the definitions of addiction and dependence.For all practical purposes these terms are used interchangeably, and they include the three components that (by modern and current usage) define chemical dependence: compulsive use, loss of control, and continued use despite adverse consequences. Why then, in this nomenclature, does addiction include "compulsive use" and "continued use despite... harm," but dependence simply "implies" "loss of control?" Further confusion arises when (psychoactive substance) dependence is used in DSM-III (revised) as a diagnostic entity that includes all three components noted.Would it not make sense to use these terms interchangeably (and consistently) rather than persist in trying to define them