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DSM-V Draft Includes Major Changes to Addiction Disease Classifications

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is used by clinicians, researchers, policy makers, health care providers, and more for the classification of mental disorders. The first draft of the latest version is making significant changes to addiction disease classifications, eliminating the disease categories for substance abuse and replacing them with a “addictions and related disorders” category.

A press release explained that eliminating the addiction categories will help clinicians differentiate between the compulsive, drug-seeking behavior of addiction and tolerance and withdrawal that some people experience when using prescription medication. Charles O'Brien, M.D., Ph.D., chair of the American Psychiatric Association’s DSM Substance-Related Disorders Work Group, said that the word “dependence” can be misleading because people may confuse it with “addiction.” He added that tolerance and withdrawal are normal responses to some prescription medication.

The new category of addictive disorders would be broken down into drug type, including alcohol-use disorder and cannibis-use disorder, and “drug craving” would be added to the criteria. The authors plan to eliminate the “problems with law enforcement” criteria because of cultural considerations.

The new version will also include criteria for cannabis withdrawal, which can include symptoms of irritability, anger or aggression, anxiety, insomnia, depression, decreased appetite, and physical symptoms such as stomach pain, shakiness, sweating, chills, and headache.

There would also be a new category of “behavioral addictions” such as compulsive gambling. Internet addiction was considered, but will be included in the index instead due to a lack of research data.

O’Brien said that the term “addiction” will be applied to more than alcohol and drug disorders, considering growing evidence that compulsive behaviors such as problem gambling are very similar to substance-use disorders in that they all affect the brain’s reward system. Compulsive behaviors involving sex and food could eventually be included.

The APA is also considering creating a category for people who suffer from withdrawal symptoms when they stop taking certain types of anti-depressants.

Source: Join Together, Bob Curley, DSM-V Draft Includes Major Changes to Addictive Disease Classifications, February 12, 2010

Posted on February 12th, 2010

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