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Substance Abuse Terminology FREE

W. Wolfgang Fleischhacker, MD; Christian Barnas, MD
JAMA. 1988;260(4):478-478. doi:10.1001/jama.1988.03410040049023
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To the Editor.—  Rinaldi et al1 have to be congratulated on raising an important issue in their article on the classification and standardization of substance abuse terminology. One of the problems with many current psychiatric classification systems is that they lack validation. Since we suppose that validation is the next logical step in the Task Force's concept, we would like to point out one of the potential pitfalls of their definitions.Severe withdrawal phenomena have been described after abrupt cessation of therapeutic doses of benzodiazepines following long-term intake.2 This syndrome has been named low-dose dependence.3 It is usually discovered serendipitously, when patients abruptly stop taking their benzodiazepines. Many of these patients have been using the medication for years, without ever trying to stop and without developing tolerance to the drug's therapeutic effects.4 We feel that these patients fail to meet the dependence criteria of most classification

REFERENCES

Rinaldi RC, Steindler EM, Wilford BB, et al:  Clarification and standardization of substance abuse terminology . JAMA 1988;;259:555-557.
Rickels K, Case WG, Downing RW, et al:  Long-term diazepam and clinical outcome . JAMA 1983;;250:767-771.
Laux G, Puryear DA:  Benzodiazepines: Misuse, abuse and dependency . Am Fam Physician 1984;;30:139-147.
Barnas C, Fleischhacker WW, Stuppack C, et al:  Investigation of benzodiazepine consumers concerning intake habits, signs of abuse and dependence and information about the drug . Pharmacopsychiatry , in press.
Diagnostic and Statistical Manual of Mental Disorders (Revised), ed 3. Washington, DC, American Psychiatric Association, 1987;.
WHO Expert Committee on Addiction-Producing Drugs , Technical Report Series, 13th report, No. 273. Geneva, World Health Organization, 1964;.

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Rinaldi RC, Steindler EM, Wilford BB, et al:  Clarification and standardization of substance abuse terminology . JAMA 1988;;259:555-557.
Rickels K, Case WG, Downing RW, et al:  Long-term diazepam and clinical outcome . JAMA 1983;;250:767-771.
Laux G, Puryear DA:  Benzodiazepines: Misuse, abuse and dependency . Am Fam Physician 1984;;30:139-147.
Barnas C, Fleischhacker WW, Stuppack C, et al:  Investigation of benzodiazepine consumers concerning intake habits, signs of abuse and dependence and information about the drug . Pharmacopsychiatry , in press.
Diagnostic and Statistical Manual of Mental Disorders (Revised), ed 3. Washington, DC, American Psychiatric Association, 1987;.
WHO Expert Committee on Addiction-Producing Drugs , Technical Report Series, 13th report, No. 273. Geneva, World Health Organization, 1964;.
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