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 onset in adulthood. This concept paper proposes the term Complex Addiction-Developmental Disorder (CADD) to conceptualise this clinical entity. By analogy with the distinction between Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (C-PTSD) — where the latter arises from repeated trauma exposure during developmentally sensitive phases and entails profound disturbances of identity and affect regulation — it is argued that repeated substance use during childhood and adolescence does not merely represent an early-onset form of known SUD, but constitutes a structurally distinct psychopathology with its own risk profiles, treatment implications, and longitudinal characteristics. The core feature of CADD is the constitution of substance-bound self- and identity-components through repeated exposure during active neuroplastic phases of personality development. This gives rise to specific clinical characteristics: a substance-as-attachment-object dynamic beyond hedonic craving, a crisis phenomenology during abstinence that resembles attachment disruption, and a therapeutic primacy of identity integration over detoxification. The concept has not yet been empirically validated and is presented as a hypothesis for further scientific discussion and examination.