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The DSM’s Role in Defining Addiction

When an individual engages in prolonged and untreated substance abuse, it’s only a matter of time before abuse turns to addiction if there’s no action taken. The brain undergoes dramatic changes to the point at which everything the individual values and enjoys takes a backseat to their pursuit of drugs or alcohol. On the bridge from substance abuse to addiction, however, there is a stretch of territory in which patients and their loved ones may find themselves asking: “Am I really addicted?” While this may seem like an easily answered question, there are a variety of factors that ultimately inform the diagnosis and help substance users and their families determine the next step in care.

For a disease in which denial plays such a significant role, there are only a few universally recognized sets of guidelines to which we can refer when assessing degrees of substance abuse. One of these is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). This regularly updated volume of guidelines reflects changes in the ongoing treatment and investigation of psychiatric illness.

How, then, does this respected and established authority define the disease of addiction in its most recent incarnation?

Important Changes

In the fifth and latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V), the previously separated conditions of substance abuse and substance dependence were combined to fit into one condition measured on a continuum, from mild to severe. This blurs the clinical lines a bit between substance abuse and addiction. Each addictive substance, other than caffeine, is addressed as a separate use disorder; however, they are all largely diagnosed based on a uniform set of criteria. Whereas a diagnosis of substance abuse previously required only one symptom, mild substance use disorder in DSM-5 requires two to three symptoms from a list of 11. These include, in their entirety:

  • Taking drugs or alcohol in larger amounts or over a longer period than was intended.
  • Persistent desire or unsuccessful efforts to cut down or control drug or alcohol use.
  • Spending a great of time on activities necessary to obtain, use or recover from drugs and alcohol.
  • Craving, or a strong desire or urge to use drugs and alcohol.
  • Recurrent drug or alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
  • Continued drug or alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  • Ceasing or reducing important social, occupational, or recreational activities because of drug or alcohol use.
  • Recurrent alcohol or drug use in situations in which it is physically hazardous.
  • Continued drug or alcohol use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
  • Tolerance, as defined by either of the following: a) A need for markedly increased amounts of drug or alcohol to achieve intoxication or desired effect b) A markedly diminished effect with continued use of the same amount.
  • Withdrawal, as manifested by either of the following: a) Characteristic withdrawal syndrome. b) Taking drugs and alcohol to relieve or avoid withdrawal symptoms.

Why Do We Listen to The DSM?

The DSM is one of the gold standards of information regarding the diagnosis and treatment of drug and alcohol use disorder. In addition to being the product meticulous research and continuous years-long clinical study, the book’s findings directly influence new trends in the diagnoses of these disorder and how treatment is administered. It can even have significant impact on how your insurance provider classifies your level of substance abuse or that of your loved one. Finally the criteria contained in the DSM can be the determining factor in answering that critical question: “Am I or is my loved one addicted?”

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