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DSM-5: What the Most Recent Version of the Psychiatry Manual Means for Addiction

The DSM is often referred to as the “Bible of Psychiatry” because it provides the official definitions of psychological conditions, including addiction. Any changes made to the DSM have a major impact on the way patients with psychological conditions are treated and the types of treatment insurance companies will cover.

Because psychological disorders typically lack the hard medical evidence that physical conditions often provide, it makes identifying and defining them challenging. It is even more challenging because these disorders often present differently from person to person. The fifth version of the DSM (DSM-5), which will be released in May 2013, is an attempt to improve the classifications, diagnosis methods and treatment recommendations of psychological disorders, including addiction. While the responses to these changes have been mainly positive, many have concerns there will be some significant negative consequences from this new DSM edition.

What Changes were made to Addiction?

  • The terms “abuse” and “dependence” are being removed. Many believed these words caused misunderstandings, especially the word “dependence,” which could easily confuse the body’s withdrawal and tolerance processes with an actual drug addiction. The term “abuse” was said to lack scientific support. “Use disorder” is the new term to describe drug or alcohol addiction.
  • “Craving/strong desire to use” is now a criterion for addiction.
  • Substance abuse disorders will no longer be grouped together. Instead, each drug identified has its own category in order to more accurately diagnosis individual situations.
  • As a whole, “use disorders” will now be classified as addictions.

Major Concern with the DSM-5: Possible Increase in Using Drugs to Treat Addiction

Now that all use disorders are considered addictions, the concern is this updated definition of addiction will lead to a significant increase in addiction diagnoses, causing “false epidemics” that result in unnecessary treatment — especially pharmacologic treatment. The new definition could result in insurance companies encouraging the use of pharmaceutical drugs to medicate individuals suffering from addiction because this type of treatment costs less than rehab. True addictions, however, cannot be successfully treated by any medication. The use of more drugs is not an effective way to combat an addiction, and it could cause more harm in the end. Individuals who only receive pharmaceutical medications for their addiction are also more likely to experience relapse. Moreover, medication used for the treatment of addiction alone does not effectively treat people who suffer from a dual-diagnosis — those who have an underlying psychological condition like depression or bipolar disorder. Dual-diagnosis is common among addicts and cannot be successfully identified and treated without rehab. It is important to remember the only way to truly treat drug or alcohol addiction is through rehabilitation therapy. A proper assessment and personalized plan that incorporates different modalities of treatment, from psychiatric to counseling, are keys to lifelong recovery. Rehab helps individuals recognize the underlying issues that may be causing or triggering the addiction. A true understanding of why an individual feels the need to self-medicate is essential to the healing process. This type of care and attention cannot be found in any pill.

How the DSM-5 will Help Those Suffering from Addiction

Aside from the controversy some of these changes have brought about, many of the changes are considered beneficial. People suffering from addictions will no longer need to use the word “abuse” to define their use of drugs or alcohol. “Use disorder” is a term that clearly defines an individual’s condition without conjuring up any type of unnecessary negativity or blame on the person with the addiction. In addition, users of prescription drugs who have become physically dependent on their medication no longer have to struggle with the idea that they can control their addiction. The elimination of the word “dependence” helps clarify an addiction as a much deeper disease than a simple dependence that can be managed by tapering off the said medication. For those with an addiction, reducing use is not easy and requires professional help. Not only do their bodies withdrawal from the drug, so does their brain. They rely on the drug to function in their everyday lives. The term “dependence” also did not appropriately represent individuals suffering from a psychological addiction. Those with a psychological addiction may not have a physical dependence, but they are still very much addicted. “Craving/strong desire to use” more appropriately describes this type of addiction. Thanks to this update, rehabilitation treatment should be more available for individuals with psychological addictions.

What Will Happen?

It is possible the DSM-5 could cause an overwhelming increase in the number of addictions diagnosed. This could, in turn, lead to a surge of over-medicating, resulting in big bucks for doctors and pharmaceutical companies, while people suffering from severe addictions will find it harder to get the help they really need. Or, it could mean insurance companies will be more willing to cover rehabilitation therapy.

  • Craving/strong desire to use” is now a criterion for addiction.
  • Substance use disorders will no longer be grouped together. Instead, each drug identified has its own category in order to more accurately diagnosis individual situations.
  • As a whole, “use disorders” will now be classified as addictions.

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