Drug Abuse Heterogeneity and the Search for Subtypes
In addition to the research on the association between substance use disorders and antisociality, there is a large body of literature reporting connections with behavior disinhibition and affect dysregulation. It is not possible in this short chapter to review these and other findings on risk factors for substance use disorders. However, the above discussion illustrates the convergences in the research findings on risk factors that point to possible clusters having implications for further understanding the heterogeneity of substance abuse and the identification of drug abuse subtypes.
It is also not possible in this chapter to discuss important related issues, such as the relationship of heterogeneity to substance use disorder phenotypes and endophenotypes, the role of protective factors in the divergence of subtypes, the relationship of co-morbid psychiatric conditions and developmental psychopathology to heterogeneity, developmental influences, and individual and group diversity, and the implications of heterogeneity and subtypes for prevention and treatment. Despite the unanswered questions, however, it is clear that investigation of the heterogeneity of substance use disorders and their underlying processes can advance our ability to effectively understand, prevent and treat substance abuse.
It is clearly important to go beyond the recognition of the heterogeneity of drug abuse and to look for systematic variations in the etiology and manifest patterns of substance abuse. There may be critical variations in the underlying processes of substance abuse as well as significant systematic differences in the observable behavior patterns. Distinguishing major divergences in the differing patterns may lead to the identification of clinically significant subtypes, help determine the underlying processes of substance abuse, and facilitate the study of the ways in which environmental factors interact with individuals’ characteristics (and the underlying processes of substance abuse) to result in different subtypes. While the available research does not answer the question of whether there are drug abuse subtypes, it does provide encouragement to continue the search.
KeywordsSubstance Abuse Personality Disorder Conduct Disorder Drug Abuse Heterogeneity Antisocial Personality Disorder
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