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Diagnostic and Statistical Manual of Mental Disorders (DSM)

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The Diagnostic and Statistical Manual of Mental Disorders (DSM) serves as the primary classification system for mental health disorders, providing standardized diagnostic criteria for clinicians and researchers. First published by the American Psychiatric Association (APA) in 1952, the DSM has undergone several revisions to reflect evolving psychiatric understanding. The fifth edition, DSM-5, released in 2013, introduced key updates that expanded diagnostic categories and modified diagnostic...

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Addiction and dependence in DSM-V.

Charles O'Brien¹

¹Center for Studies of Addiction, University of Pennsylvania, Philadelphia, PA 19104-6178, USA. obrien@mail.trc.upenn.edu

Addiction (Abingdon, England)

|April 12, 2011

Summary

The Diagnostic and Statistical Manual of Mental Disorders (DSM) V proposes changes to substance use disorder diagnoses, including renaming the section to Addiction and Related Disorders and removing the abuse/dependence dichotomy for clarity.

Area of Science:

Psychiatry
Neuroscience
Clinical Psychology

Background:

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has historically used terms like 'addiction' and 'dependence' for substance use disorders.
The term 'dependence' has dual meanings: physiological adaptation and uncontrolled drug-seeking behavior, causing clinical confusion.
This confusion may contribute to the under-treatment of pain due to physician concerns about prescribing opioids.

Purpose of the Study:

To outline proposed changes to the substance use disorders section for the fifth revision of the DSM (DSM-V).
To address the ambiguity surrounding the terms 'addiction' and 'dependence' and their impact on clinical practice.
To explore how revised nomenclature and criteria may improve diagnosis and treatment of substance use disorders.

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Main Methods:

Review of historical nomenclature in previous DSM editions.
Analysis of proposed changes for DSM-V, including chapter title alterations and criterion modifications.
Examination of the rationale behind eliminating the abuse/dependence dichotomy.

Main Results:

The DSM-V proposes renaming the chapter to 'Addiction and Related Disorders', incorporating disordered gambling.
Specific substance use disorders may be termed 'alcohol use' or 'opioid use' disorders.
Key changes include removing the 'committing illegal acts' criterion and adding a 'craving' criterion, alongside eliminating the abuse/dependence distinction.

Conclusions:

The proposed changes in DSM-V aim to enhance clarity in the diagnosis and treatment of substance use and related disorders.
Revising terminology and diagnostic criteria may help alleviate confusion and improve clinical management, particularly concerning pain treatment.
The elimination of the abuse/dependence dichotomy is based on a lack of supporting data for an intermediate stage.