BACKGROUND: The existence or non-existence of the formal diagnosis 'substance' or 'dependence' is in fact of little consequence in terms of the severity of the affliction, the course of the disorder and the response to a specific type of treatment. Furthermore, the effective treatments that are currently available seem to work only in a minority of the patients in routine clinical practice. A possible reason for these discrepancies is too much heterogeneity within the diagnostic categories. The planned merging of the diagnoses 'substance abuse' and 'dependence' into a single diagnostic category 'substance use disorder' in DSM-5 is likely to increase the heterogeneity still further. AIM: To provide suggestions for improvement of diagnosis and treatment through staging and profiling of addiction and dependency. METHOD: Study of the relevant literature. RESULTS: A possible solution is to reduce the heterogeneity by the introduction of staging and profiling. Therefore, we present a model for addiction which is based on existing models in oncology and on current knowledge about the neurobiology of addiction. In addition, we demonstrate in what way individual patients with an addiction can be characterised and profiled in more detail through the use of phenotypical, endophenotypical and genetic information. CONCLUSION: The combination of diagnosis, staging and profiling will lead to more effective and efficient treatment for patients suffering from addiction.
BACKGROUND: The existence or non-existence of the formal diagnosis 'substance' or 'dependence' is in fact of little consequence in terms of the severity of the affliction, the course of the disorder and the response to a specific type of treatment. Furthermore, the effective treatments that are currently available seem to work only in a minority of the patients in routine clinical practice. A possible reason for these discrepancies is too much heterogeneity within the diagnostic categories. The planned merging of the diagnoses 'substance abuse' and 'dependence' into a single diagnostic category 'substance use disorder' in DSM-5 is likely to increase the heterogeneity still further. AIM: To provide suggestions for improvement of diagnosis and treatment through staging and profiling of addiction and dependency. METHOD: Study of the relevant literature. RESULTS: A possible solution is to reduce the heterogeneity by the introduction of staging and profiling. Therefore, we present a model for addiction which is based on existing models in oncology and on current knowledge about the neurobiology of addiction. In addition, we demonstrate in what way individual patients with an addiction can be characterised and profiled in more detail through the use of phenotypical, endophenotypical and genetic information. CONCLUSION: The combination of diagnosis, staging and profiling will lead to more effective and efficient treatment for patients suffering from addiction.