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In 1968 the term drag dependence replaced the term drug addiction in the diagnostic nomenclatures of the World Health Organization (WHO) and the American Psychiatric Association (APA). Since then, dependence has become the generally accepted diagnostic term for compulsive use of a psychoactive substance, but addiction still appears with noteworthy frequency in professional and scientific publications. Which is better? That is, which of the two terms better conveys the idea of compulsive substance use? Here we review the historical and current usage of these two diagnostic terms and evaluate the arguments for use of one or the other. To clarify usage, we note some of the diagnostic features associated with addiction or dependence at different historical periods, but we do not attempt a comprehensive review of historical and current concepts and definitions of substance use disorders. Informative reviews of these related issues have been provided by Berridge1 and Babor.2 Our commentary is focused on choice of terms.
Historical usage
The term addiction is derived from the Latin verb addicere, which referred to a Roman court action of binding a person to another. The term later came to mean attachment or devotion to an activity. Addiction and variants thereof were used in the 17th and 18th centuries to refer to use of psychoactive substances. The expressions, "addicted to the wine or strong drinke", "addictedness to drinking" and "addiction to tobacco" were used by Simpson & Weiner3 (pp. 103-104). In 1810 Benjamin Rush4 recommended establishment of a facility in Philadelphia for treatment of "persons addicted to the excessive use of ardent and fermented liquors" (p. 354). When the modern concept of addiction was developed in the late 18th and early 19th centuries, it included the essential feature of loss of control of the substance use.5 During the 19th century, medical writers sometimes used addiction to refer to compulsive use of alcohol or opiates, but they more often used other terms.6,7 For chronic or repeated intoxication on alcohol, the commonly used terms were drunkenness, inebriety and intemperance. For compulsive opiate use, the commonly used terms were opium habit, opium disease, morphia habit, morphinism and morphinomania. The term alcoholism was coined in Europe in the 19th century,8 but was not commonly used as a diagnostic term until the 20th...