by William Van Ornum, Ph.D. on
In the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR), there are separate categories for substance abuse and substance dependence. Writing in Counseling Today, the magazine of the American Counseling Association, K. Dale Jones notes that in the upcoming DSM V it is likely that these two categories will be eliminated and replaced with one category called substance use disorder. Jones writes:
“In the past 20 years, a large body of research has documented numerous problems with the differentiation between the abuse and dependence disorders. Problems between the differentiation became evident early on from reliability and validity studies. Although reliability of the DSM-IV dependence was strongly and consistently supported, reliability for abuse was lower and more variable. Further, some questioned whether diagnosing substance abuse on the basis of one symptom was appropriate, particularly when studies found more than 70 percent of individuals with alcohol abuse met only one criteria: drunk driving.
“The proposed criteria for substance abuse disorder include 11 diagnmostic criteria that are very similar to those now used for the substance abuse and dependence disorders in the DSM-IV-TR. However, a new diagnostic symptom representing craving has been added. Defined as a strong desire for a substance, craving is a common clinical symptom that typically is present in those with more severe levels of the disorder. In addition, the legal problem criteria (currently found in the abuse diagnosis) will likely be eliminated due to the low prevalence relative to other abuse criteria.
“Some professionals are expressing concerns about the proposed changes. One concern is that the new substance abuse disorder category is too broad and would make appropriate treatment or level of care difficult. Furthermore, there is fear that subsuming substance abuse disorder might result in stigmatizing individuals whose substance abuse problems are intermittent, temporary, or based on environmental and developmental factors.”
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