Reconceptualizing Substance Use Disorders and Comorbidity

Since 1952, psychiatry has grappled with the concept of addiction in terms of diagnosis, treatment, and research; this work has been particularly complex given the common co-occurrence of other mental health concerns. Tracing the history of substance use disorder (SUD) comorbidity and exploring related concepts of dual diagnosis, co-occurring disorders, and multimorbidity highlights the necessity for a strong addiction comorbidity framework. In this commentary, we contend that to continue advancing our understanding of addiction comorbidities, a more nuanced and explicit framework is needed. Specifically, one that moves beyond the limitations of dual diagnosis and multimorbidity, and embraces a more integrative, biopsychosocial approach. The DSM offers a critical opportunity for dialogue and development of psychiatric comorbidity frameworks to guide future research, clinical practice, and educational initiatives in the field of addiction and mental health.