DSM-V Draft Includes Major Changes to Addictive Disease Classifications

Source: JoinTogether News Feature, 2/12/2010

The first draft of the American Psychiatric Association’s (APA) latest Diagnostic and Statistical Manual of Mental Disorders (DSM-V) eliminates the disease categories for substance abuse and dependence and replaces it with a new “addictions and related disorders” — just one of several major changes to the “Bible” used almost universally to diagnose (and get insurance reimbursement for) behavioral-health problems.

“Eliminating the category of dependence will better differentiate between the compulsive drug-seeking behavior of addiction and normal responses of tolerance and withdrawal that some patients experience when using prescribed medications that affect the central nervous system,” the APA explained in a Feb. 10 press release.

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The new category for addictive diseases would include a variety of “substance-use disorders” broken down by drug type, such as “cannabis-use disorder” and “alcohol-use disorder.” Diagnostic criteria for these disorders in DSM-V would remain “very similar” to those found in the current DSM-IV, according to APA. However, the symptom of “drug craving” would be added to the criteria, while a symptom that referred to “problems with law enforcement” would be eliminated “because of cultural considerations that make the criteria difficult to apply internationally,” APA said.Also new to the DSM-V are diagnostic criteria for “cannabis withdrawal,” which the APA says is caused by “cessation of cannabis use that has been heavy and prolonged,” results in “clinically significant distress or impairment in social, occupational, or other important areas of functioning,” and is characterized by at least three of these symptoms: irritability, anger or aggression; nervousness or anxiety; sleep difficulties (insomnia); decreased appetite or weight loss; restlessness; depressed mood; and or physical symptoms such as stomach pain, shakiness or tremors, sweating, fever, chills, and headache.

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The proposed DSM-V also would add a new category of “behavioral addictions” which contains a single disorder: gambling addiction. “Internet addiction was considered for this category, but work group members decided there was insufficient research data to do so, so they recommended it be included in the manual’s appendix instead, with a goal of encouraging additional study,” according to an APA press release.

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APA is accepting public comments on the DSM-V revisions until April 20. “This is the first complete revision of the DSM since 1994,” said Volkow in a Feb. 11 letter to addiction professionals. “… In light of the advances in research on substance abuse and addiction since the last revision, many suggested changes have been proposed in this revision. Therefore, this is an important opportunity to offer your comments on the new criteria.”

All of the proposed changes and information about submitting comments can be found on the DSM-V website.Read the entire JoinToger News Feature

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