Friday, August 21, 2020

DSM-5 Substance Abuse Disorders Draws Controversy

DSM-5 Substance Abuse Disorders Draws Controversy Addiction Alcohol Use Print DSM-5 Alcohol Use Disorder Diagnosis Draws Controversy Diagnosis manual combines alcohol abuse and alcohol dependence By Buddy T facebook twitter Buddy T is an anonymous writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism. Learn about our editorial policy Buddy T Medically reviewed by Medically reviewed by Steven Gans, MD on June 27, 2016 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on July 25, 2019 Diagnosing Alcohol Abuse Disorders. Getty Images More in Addiction Alcohol Use Binge Drinking Withdrawal and Relapse Children of Alcoholics Drunk Driving Addictive Behaviors Drug Use Nicotine Use Coping and Recovery After more than a decade of revisions, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013 by the American Psychiatric Association (APA)รข€"but not without controversy. The DSM-5 is widely used by health professionals to diagnose behavioral health problems and is used for insurance billing purposes. Several sections of the new DSM-5 have come under criticism, including the section dealing with alcoholism. Alcohol Abuse Disorders In the previous version of the manual, DSM-IV, published in 1994, alcohol use disorders were divided into two categories,  alcohol abuse and alcohol dependence. According to the APA, The distinction between abuse and dependence was based on the concept of abuse as a mild or early phase, and dependence as the more severe manifestation. Instead of two separate diagnoses, the revised manual has a single diagnosis of alcohol use disorder (AUD) which, according to the APA, will better match the symptoms that patients experience. The Diagnostic Criteria for AUD In the fifth edition of the manual, AUD can be categorized as mild, moderate or severe. The diagnosis is based on 11 criteria. The severity of the disorder is graded by the number of criteria the individual meets. From 0 to 1, the person does not have an AUD. From 2 to 3, the diagnosis is mild; from 4 to 5, moderate; and 6 or more, severe. How Is the DSM-5 Used? Confusion Over the Term Dependence According to the APA, a reason for combining the two separate diagnoses into one was primarily because the diagnosis of alcohol dependence caused confusion. Most people thought dependence meant addiction. Dependence, however, can be your normal body response to using a substance, such as when you become physiologically dependent on a medication while following your doctors prescribed regimen. 11 Criteria for an Alcohol Abuse Disorder Diagnosis The following abbreviated descriptions are what health professionals use for diagnosis as the  11 criteria of alcohol use disorder: Missing work or schoolDrinking in hazardous situationsDrinking despite social or personal problemsCraving for alcoholBuild up of toleranceWithdrawals when trying to quitDrinking more than intendedTrying to quit without successIncreased alcohol-seeking behaviorInterference with important activitiesContinued use despite health problems The craving criteria replaced a previous symptom of reoccurring legal problems due to drinking, which the APA eliminated because of varying cultural considerations that made the criteria difficult to apply internationally. Critics Claim Alcoholism Mislabeled With New Criteria According to the new criteria, a college student who binge drinks on weekends and occasionally misses a class would be diagnosed with a mild alcohol abuse disorder. This is part of where the controversy lies. Critics say the revised criteria could lead to college or underage binge drinkers to be mislabeled as mild alcoholics, a diagnosis the could follow them into their later years. How Prevalent Is Alcoholism? Task Force Believes Newer Manual Provides for More Accurate Diagnosis The task force that helped revise the manual claims the new criteria is a step in the right direction toward a more accurate diagnosis of the disorder. The field of substance abuse and addiction has witnessed an explosion in important research in the past two decades, said Dr. David Kupfer, chairman of the DSM-5 task force. The changes reflect the best science in the field and provide new clarity in how to diagnose these disorders. One of the authors of the previous DSM-IV disagrees that research should be the only factor in diagnosis. The DSM-5 decision to lump beginning drinkers with end-stage alcoholics was driven by researchers who are not sensitive to how the label would play out in young peoples lives, said Dr. Allen Frances, chairman the DSM-IV task force. What Research Suggests One 2013 study by researchers at Virginia Commonwealth University that studied 7,000 twins shows that the new criteria do not result in an improved alcohol-related diagnosis. The new criteria do not result in less accurate diagnoses either. Needless Increase in Diagnoses Critics of the revisions claim the DSM-5 expands the list of what is considered mental illness and leads to a needless increase in diagnoses. The most damaging criticism of the DSM-5 came from the National Institute of Mental Health (NIHM), which withdrew its support of the manual two weeks before its publication. The NIMH, the largest funding agency for mental health research, announced that it would be reorienting its research away from DSM categories. Meeting Criteria Is Not Enough for Diagnosis According to Dr. Thomas Insel, director of the NIMH when the manual was released, claimed that the main problem with the DSM-5 was validity. Meeting criteria does not go far enough to warrant a diagnosis. He said, This would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever, implying that symptoms alone rarely indicate the best choice of treatment or an accurate diagnosis. The NIMH is in the process of developing its own Research Domain Criteria (RDoC) as an alternative to the DSM.  It would find  new ways of  classifying mental disorders  based on dimensions of observable behavior and objective neurobiological measures. How Mental Illnesses Are Diagnosed

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