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A new version of the Bible for psychiatric conditions that is yet to be released is already stirring up controversy. The DSM, which stands for the Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and gives common language, classification, and diagnostic measures for mental disorders. The edition currently in use is the fourth and is called DSM-IV. The book is used as a guide for clinicians making diagnoses, medical researchers, pharmaceutical companies, health insurance companies, policy makers, and other professionals. It is the final word on mental illness.
The fifth edition of the Manual is expected to be published in May of 2013, but some of the expected changes and updates are already known. Guidelines for defining and diagnosing addiction have long been controversial, but the changes to this topic in the DSM-V are already adding new fuel to the fire.
The Current Definition
Currently, the DSM categorizes problems with substances, whether alcohol or drugs, in two groups: abuse and dependence. Substance abuse is a short-term misuse of a drugs or alcohol. Someone who abuses alcohol, for instance, may binge drink at times, may have hangovers, and may miss out on responsibilities because of occasional heavy drinking. Dependence on alcohol on the other hand, is a chronic problem and is also used interchangeably with the terms addiction and alcoholism. Someone who is dependent on alcohol has built up a tolerance to it, experiences withdrawal without it, and continues to drink over the long term in spite of the problems it causes.
DSM-V will make changes to the current definitions for addiction. In fact, it will remove the terms abuse and dependence entirely. Many believe the elimination of the terms is positive. The word dependence is confusing and misleading, while abuse carries a stigma with it. The new manual will take away the two terms and replace it with just one: addiction. It will also subdivide that term into mild, moderate, or severe categories. The list of symptoms used to recognize addiction will be expanded in the DSM-V, while at the same time, the number of symptoms needed to make a diagnosis of addiction will be decreased.
Other changes to the manual include the addition of gambling as a recognized addiction. Currently, only addictions to substances are considered valid, while other behaviors such as excessive shopping or overeating, are considered compulsive rather than true addictions. A broad new category of addiction is expected in the DSM-V called behavioral addiction. This would encompass sex, shopping, video game, internet, and other addictions.
The predicted updates to the addiction section of the DSM are already stirring up discussion, debate, and controversy. The major concern with the changes to the addiction definition and diagnosis is that it will drastically increase the number of diagnoses of alcoholism. According to the proposed new criteria for diagnosing alcoholism, nearly 40 percent of college students would fall into the category. This is because binge drinking would be considered a symptom of mild addiction. Those who oppose the new definition of addiction believe that the rise in diagnoses would cost huge amounts to health care. They also cite the fact that those who are abusing alcohol, such as college binge drinkers, are not necessarily going to become alcoholics. There is, they say, a distinction between abuse and true addiction and that while the former may lead to the latter, in most cases it does not.
Proponents of the changes believe that the new definitions will allow doctors and other health care professionals to intervene earlier in the process of a person who is becoming an alcoholic. They state that while the immediate health care costs would go up, there would be savings in the long term as alcoholics and other addicts receive early interventions.
Aside from the definition of addiction and its possible consequences, the new changes to the DSM highlight controversies over the manual itself. While other areas of medicines have such manuals which outline diagnoses, testing, and create a common language, no other manual has such wide-reaching influence as the DSM. Because so many organizations rely on it, the manual affects the lives of millions of people. It is written in secrecy by a panel of 162 professionals and it brings in over $5 million in revenue to the American Psychiatric Association. Comments that have been brought to the association over the proposed changes have not been made public, further spurring controversy and debate.