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Monday, February 15, 2010

Battle Over 'Addiction' and 'Dependence'

Battle Over Addiction Dependence

The American Psychiatric Association's (APA) has finished the first draft of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The DSM-IV is used all over the world to diagnose behavioral and mental disorders, and to help provide patients reimbursement for medical bills from insurance companies. There will be several changes, many of which involve the areas of the DSM that deal with addiction and dependence. There has been a battle over 'addiction' and 'dependence' and how those words should be properly used. The first draft of the DSM-V no longer has disease categories for substance abuse and dependence, "addictions and related disorders" is the desired new wording.

In a press release on Feb, 2010, the APA explained that: "eliminating the category of dependence will better differentiate between the compulsive drug-seeking behavior of addiction and normal responses of tolerance and withdrawal that some patients experience when using prescribed medications that affect the central nervous system". "Substance-use disorders" will be classified by the particular substance type, i.e. "heroin-use disorder" or "cocaine-use disorder" will be the appropriate terminology when diagnosing. One difference in the new draft from the DSM-IV is the symptom of "drug craving"; the symptom would be added to the criteria; according to the APA "problems with law enforcement" would be eliminated from the criteria "because of cultural considerations that make the criteria difficult to apply internationally".

Gambling addiction looks like it will make the cut for the new DSM - finally. A new category of "behavioral addictions" would be created, but it will probably only contain one disorder (gambling) because other behavioral disorders have not had enough research. According to the APA, "Internet addiction was considered for this category, but work group members decided there was insufficient research data to do so, so they recommended it be included in the manual's appendix instead, with a goal of encouraging additional study". This is a big deal, for the first time, the term "addiction" would be tied to disorders other than drugs and alcohol. Charles O'Brien, M.D., Ph.D., chair of the APA's DSM Substance-Related Disorders Work Group, said, "There is substantive research that supports the position that pathological gambling and substance-use disorders are very similar in the way they affect the brain and neurological reward system". Although, in the DSM-V draft, sex and food disorders will still fall outside and not be included in the "behavioral addictions" category; instead, sex disorders will be included In the "hyper-sexuality" category and food problems will be classified as "binge eating" disorders.

The APA will be accepting comments on the proposed DSM-V revisions until April 20. The world has a much better understanding of the science of addiction, many breakthroughs in understanding have happened since the DSM-IV was released in 1994.

All of the proposed changes and information about submitting comments can be found on the DSM-V Website

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