The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations

Abstract

This article provides an overview of the history of substance use and misuse and chronicles the long shared history humans have had with psychoactive substances, including alcohol. The practical and personal functions of substances and the prevailing views of society towards substance users are described for selected historical periods and within certain cultural contexts. This article portrays how the changing historical and cultural milieu influences the prevailing medical, moral, and legal conceptualizations of substance use as reflected both in popular opinion and the consensus of the scientific community and represented by the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). Finally, this article discusses the efforts to classify substance use disorders (SUDs) and associated psychopathology in the APA compendium. Controversies both lingering and resolved in the field are discussed, and implications for the future of SUD diagnoses are identified.

Keywords: DSM; addiction; alcohol; cannabis; cocaine; diagnostic classification; historical; nosology; opioids; substance use disorders.

Figure 1

Selection of additional/supplementary historical events and perspectives related to the use of substances over time, nosological developments, and other domains relevant to the main text. Notes: ^a [3]; ^b [4]; ^c [5]; ^d [6]; ^e [2]; ^f [7]; ^g [8]; ^h [9]; ⁱ [10]; ^j [11]; ^k [12]; ^l [13]; ^m [14]; ⁿ [15]; ^o [16]; ^p [1]; ^q [17]; ^r [18]; ^s [19]; ^t [20]; ^u [21]; ^v [22]; ^w [23].