DSM 5 Diagnostic Criteria for Substance Use Disorders

DSM 5 Diagnostic Criteria for Substance Use Disorders Addiction Drug Use Print DSM-IV to DSM 5 Diagnostic Criteria for Substance Use Disorders By Elizabeth Hartney, BSc., MSc., MA, PhD Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada. Learn about our editorial policy Elizabeth Hartney, BSc., MSc., MA, PhD Medically reviewed by Medically reviewed by Steven Gans, MD on August 05, 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 May 29, 2017 DSM 5 is the latest reference material on diagnosis of addictions. Ivan Petrov More in Addiction Drug Use Cocaine Heroin Marijuana Meth Ecstasy/MDMA Hallucinogens Opioids Prescription Medications Alcohol Use Addictive Behaviors Nicotine Use Coping and Recovery Why was the DSM Updated in 2013? For decades, psychologists and psychiatrists have depended on the Diagnostic and Statistical Manual of Mental Disorders to ensure that they are following best practices and evidence-based criteria for the diagnosis of mental illness, including substance use disorders. It has long been considered the gold standard of defining what constitutes mental health diagnosis. Criteria for substance use disorders changed significantly from DSM-IV to DSM 5. DSM-IV criteria for substance use disorders DSM 5 criteria for substance use disorders While each edition of the manual has reflected the best knowledge of the time, once outdated, it can come across as naive at best, and inhumane at worst. Take the example of homosexuality, for example. In DSM-III, it was considered a mental illness. Nowadays, the inclusion of homosexuality as a defined mental disorder is considered a major landmark in the history of the oppression of sexual minorities. As well as reflecting the thinking of the day, the DSM is updated to reflect up to date research in the fields of psychology, psychiatry, neuroscience, and other related areas of expertise. This research is reviewed, critiqued, analyzed and considered by the greatest minds in the field, who eventually come to a consensus about what should and should not be included in the DSM, and the criteria for each diagnosis. DSM-5 represents a landmark in the history of mental illness, in that it is the first time that the opinions of the public have been considered in developing the DSM-5 criteria. This was only possible through the internet, and the amazing ability to reach people who would never otherwise be consulted. Changes from DSM-IV to DSM-5 Diagnostic Criteria for Substance Use Disorders While many areas of mental illness have not changed significantly from DSM-IV to DSM-5, the changes to the diagnostic criteria for substance use disorders are significant. One of the most important ways that the criteria has changed is the language used to label the substance use disorders, which has changed from using the terms abuse and dependence to using the term use. Why does this matter? Lets start with the work abuse. The term is associated with cruelty, maltreatment, and harm, and is commonly associated with physical abuse or violence, emotional abuse, and most commonly, with sexual abuse. In fact, the shorthand child abuse is often used and understood to mean childhood sexual abuse. So how can this be related to substance use? A substance cant be abused, because as an inanimate object, it cant be hurt. So the abuse in the term substance abuse, which was a diagnostic label in the DSM-IV, referred to the use of substances as a form of self abuse, with the substance as the means of that abuse. But is the intention of users of substances to cause themselves harm? Perhaps not. In fact, for many people, the opposite is true. When asked why they use substances, they give reasons such as helping them to socialize or connect with others, providing themselves with positive, pleasurable experience, and helping them to relax. Then theres the term, dependence.   This is based on a now stereotypical view of addiction that addicts are helplessly enslaved by their addictions, and are unable to function without their drug or addictive behavior.   This extreme view is now known to be inaccurate, and has caused a lot of stigma and distress for people with substance use problems. The language of substance use is more accurate, and less stigmatizing to people who have substance use disorders, and represents an important shift in the thinking about addiction.