Changes in the Psych Manual

The Diagnostic Statistical Manual of Mental Disorders is up for its 5th edition. A possible revision is changing the terms of what clinicians, researchers, insurers, and others rely on to identify and classify psychiatric disorders like addictions. The revised guide, called DSM-5, will be incorporating changes to more than a dozen categories of disorders, including those related to mood, eating, and personality, as well as substance abuse and addiction. Scheduled for release in May 2013.

The new guidelines would do away with the diagnostic categories of “substance abuse,” which generally is defined by such short-term problems as driving drunk, and “substance dependence.” They would also diagnose disorders related to the use of alcohol, cigarettes, illicit or prescription drugs and other substances into a single 11-item list of problems typically associated with these disorders. The list covers issues such as being unable to restrict or control the use of that substance and failing to meet obligations at work, school or home.

This means people would be given a diagnosis based on how many criteria on that list they met: no disorder (0-1), mild disorder (2-3), moderate (4-5) or severe (6 or more).

Supporters say the proposed changes make it easier to identify and address drug or alcohol problems before they become serious. According to the National Institute on Alcohol Abuse and Alcoholism, people are at risk for developing a substance use disorder if their drinking exceeds four drinks on any single day and more than 14 drinks per week for men and seven drinks per week for women.

However, some addiction experts worry that using the 11-point list of criteria to distinguish substance abuse disorders on a continuum from mild to severe suggests that there’s a natural escalation from non-use to occasional use to risky use to addiction.

“It’s similar to depression,” he says. “People are sad when bad things happen to them, but not all are on an escalator that will lead them to psychotic depression.”

Because the new guidelines use a single spectrum for substance use and addictive disorders, some addiction experts worry this will over-diagnose many people. Overdiagnosis of people who are simply struggling with a bout of depression or self-medicating with alcohol could lead to insurance companies raising their prices due to an absorption of funds from alcohol and substance abuse treatment.