Are specific dependence criteria necessary for different substances: how can research on cannabis inform this issue?

Abstract

Aims: Research on cannabis dependence is used to comment on the similarities and differences among the substance dependence disorders, and to address the issue of whether specific versus generic substance dependence diagnostic criteria might offer the most fruitful approach to diagnosis. If cannabis dependence can be diagnosed and characterized adequately using the extant generic Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) dependence criteria, then one could argue that these diagnostic guidelines are valid and of high utility for substances with more well-accepted dependence syndromes.

Methods: A brief, selective critical review of research on cannabis withdrawal and on the validity and internal consistency of cannabis dependence as assessed via DSM criteria for cannabis dependence was performed.

Results: Findings from these reports indicate that cannabis dependence is much more similar to than different from other types of substance dependence, even with regard to withdrawal. The generic DSM-IV dependence criteria can be applied fairly well to cannabis, and yield findings similar to that observed with other substance dependence disorders. However, across substances, the generic criteria may not discriminate cases in a manner consistent with the underlying constructs of abuse and dependence, and cross-substance differences probably exist in the general dependence severity level and specific symptom profiles.

Conclusions: The use of generic DSM-IV criteria appears to work as well for cannabis dependence as for other substances, yet the more important question might be as to whether we can do better by developing more sophisticated generic criteria or by using substance specific criteria.