DSM-V splits drug dependence by specific drug

With what we know about addiction these days, it makes no sense to split the “substance dependence” diagnoses into groups by the specific drug. Addiction happens when the brain habituates to a malfunction of satisfying cravings despite increasing harms.

It’s the users that become addicted and have a problem, not the substance!

Wikipedia information on DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA).  

Substance-related and addictive disorders

Substance abuse and substance dependence from DSM-IV-TR have been combined into single substance use disorders specific to each substance of abuse within a new “addictions and related disorders” category.[25]

“Recurrent legal problems” was deleted and “craving or a strong desire or urge to use a substance” was added to the criteria.[4]

The threshold of the number of criteria that must be met was changed[4] and severity from mild to severe is based on the number of criteria endorsed.[4]

Criteria for cannabis and caffeine withdrawal were added.[4]

This almost seems like a joke and I don’t even see caffeine listed in the DSM-5 substance dependencies below.

New specifiers were added for early and sustained remission along with new specifiers for “in a controlled environment” and “on maintenance therapy”.[4]

DSM-5 substance dependencies include:

  • 303.90 Alcohol dependence
  • 304.00 Opioid dependence
  • 304.10 Sedative, hypnotic, or anxiolytic dependence (including benzodiazepine dependence and barbiturate dependence)
  • 304.20 Cocaine dependence
  • 304.30 Cannabis dependence
  • 304.40 Amphetamine dependence (or amphetamine-like)
  • 304.50 Hallucinogen dependence
  • 304.60 Inhalant dependence
  • 304.80 Polysubstance dependence
  • 304.90 Phencyclidine (or phencyclidine-like) dependence
  • 304.90 Other (or unknown) substance dependence
  • 305.10 Nicotine dependence

There are no more polysubstance diagnoses in DSM-5; the substance(s) must be specified.

Here is where we are screwed: the DSM-5 makes opioid dependence a medical diagnosis to be treated as though it were an addiction.


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