Complex Addiction-Developmental Disorder (CADD): A Proposal for a Distinct Psychiatric Entity for Substance-Related Disorders with Onset During Pre- and Adolescent Development

Substance use disorders (SUD) arising during neurobiologically sensitive developmental windows may constitute a structurally distinct diagnostic category, fundamentally different from SUD with adult onset. This concept paper proposes the term Complex Addiction-Developmental Disorder (CADD) to name and frame this clinical entity. The argument draws an analogy with the distinction between PTSD and Complex PTSD (C-PTSD): just as repeated developmental trauma does not produce the same disorder as adult trauma, repeated substance use during childhood or adolescence does not produce the same disorder as adult addiction. What it produces instead is a structurally different psychopathology — one with its own risk profiles, longitudinal characteristics, and treatment logic. The core of CADD is the constitution of substance-bound self- and identity-components through repeated pharmacological exposure during active neuroplastic phases of personality development. This gives rise to three defining clinical features: a relationship to the substance that functions like attachment rather than hedonic craving; an abstinence phenomenology resembling identity rupture rather than withdrawal; and a therapeutic priority of identity integration over detoxification. The concept has not yet been empirically validated and is offered here as a hypothesis for scientific discussion.