Why Not Add Consumption Measures to Current Definitions of Substance Use Disorders? Commentary on Rehm et al. 'Defining Substance Use Disorders: Do We Really Need More Than Heavy Use?'

The article by Rehm and colleagues in this issue of the Journal argues that diagnoses of substance use disorders should be based solely on measures of consumption. Although the authors provide convincing arguments for inclusion of consumption measures in the diagnostic criteria for substance use disorders, we do not agree that diagnostic criteria should be restricted to measures of consumption alone. Our clinical and research experience with alcohol use disorders suggests that use of consumption measures alone would fail to identify many patients whose alcohol or drug use is adversely impacting their health. Instead, we advocate-as others have done-that measures of consumption be added to current diagnostic criteria.