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Should we embrace the term ‘preaddiction’?

Neuropsychopharmacology volume 49, pages 495–496 (2024)Cite this article

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McLellan and colleagues [1] recently proposed the term “preaddiction” to improve identification of and interventions for early stage, or less severe, manifestations of substance use disorder (SUD), including “mild” and “moderate” SUD per the Diagnostic and Statistical Manual of Disorders, Fifth Edition (DSM-5). Following this, the National Institute on Drug Abuse (NIDA) and National Institute on Alcohol Abuse and Alcoholism (NIAAA) solicited feedback on the proposed label [2], noting that “preaddiction” would replace the terms “problematic substance use,” “mild substance use disorder,” and “moderate substance use disorder.” Additional goals described included raising awareness about harmful substance use, increasing screening and brief interventions, and preventing overdose.

Though NIAAA and NIDA identify important goals, they seem unlikely to be achieved through the introduction of a new label for already existing constructs. Indeed, terms capturing harmful substance use and early-stage SUD already exist such as the International Classification of Diseases (ICD-11) harmful pattern of substance use, or the DSM-5 criteria count indicating SUD severity (i.e., “mild” [endorsing 2-3 criteria], “moderate” [4-5 criteria], and “severe” [6+ criteria] designations of SUD). However, these categories are on empirically shaky ground with respect to their validity and clinical utility given the heterogeneity of the SUD symptoms themselves, particularly for DSM-5. For example, meeting criteria on the basis of craving and withdrawal (considered more severe and fundamental features of addiction) is likely different from a person who meets criteria on the basis of hazardous use (e.g., drinking and driving) and drinking despite physical/psychological problems (less severe criteria and likely secondary features of addiction [3,4,5]), though both individuals would meet “mild” SUD, or “preaddiction”, criteria. If current mild and moderate categories are not adequately raising awareness about harmful use and increasing screening and brief interventions, we should not expect improvements simply as a result of relabeling these categories to “preaddiction”. Thus, attaching additional labels to flawed severity designations would be a misstep and the field should avoid reifying limited diagnostic systems.

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Funding

Funding

Investigator effort partially supported by NIAAA K08AA030301 (PI: Boness).

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Authors and Affiliations

  1. University of New Mexico Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA

    Cassandra L. Boness

  2. Tata Institute of Social Sciences, Mumbai, Maharashtra, India

    Kanak Kataria

  3. Centre for Addictive Behaviours Research, London South Bank University, London, UK

    James Morris

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CLB, KK, and JM all contributed to conception of the work, drafting, and final approval. We all agree to be accountable for the work’s accuracy and integrity.

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Correspondence to Cassandra L. Boness.

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CLB receives research support from the National Institute on Alcohol Abuse and Alcoholism. The remaining authors declare no conflicts.

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Boness, C.L., Kataria, K. & Morris, J. Should we embrace the term ‘preaddiction’?. Neuropsychopharmacol. 49, 495–496 (2024). https://doi.org/10.1038/s41386-023-01764-4

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