The Elimination of Abuse and Dependence in DSM-5 Substance Use Disorders: What Does This Mean for Treatment?

Abstract

The recently released Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) marks the beginning of a new chapter in the diagnosis and treatment of substance use disorders. This article provides a brief overview of the changes to the criteria and how they will be used to formulate the new diagnostic index. Recent research, although limited given the timeliness of the revision, has demonstrated consistent findings with regard to the compatibility between DSM-IV and DSM-5 criteria, predominantly related to the most serious cases of substance use. There is much more variation in how milder cases will be addressed with the DSM-5 relative to the prior version. These diagnoses have significant implications for treatment, but it is imperative to acknowledge prognoses are based on the assumption that DSM-5 substance use disorders are qualitatively similar but range in severity from mild to severe. This may be a controversial approach, given that some preliminary research and lively discussion suggests the new diagnostic scheme may encompass qualitatively unique disorders ranked on a continuum. Treatment goals must take these underlying issues into account if substance use disorders are to be addressed successfully. The DSM-5 represents advancement in the diagnosis of substance use disorders, but many questions related to how it will inform treatment remain unanswered. Implications for future research are also discussed in this review.

A prospective study of behavioral health indicators and repeat jail admissions among rural inmates

“…The interview consisted of the Comprehensive Addiction and Psychological Evaluation-5 (CAAPE-5; Hoffmann, 2013), which was designed to identify many behavioral health issues in a manner that is consistent with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013). This instrument has been validated for use with various correctional samples in prior work (Proctor et al, 2014; Tracy & Carkin, 2016; Kopak et al, 2014a, b). Although the information gathered with the CAAPE–5 is used to detect probable diagnoses for research purposes, it is recommended that formal diagnoses be confirmed by a licensed professional for routine clinical use.…”

“…In addition, jail administrators are well aware of the return rates of inmates with serious mental illness (AbuDagga et al, 2016), but the inherent challenges in working this population have left most researchers relying on state databases from large metropolitan areas which contain outdated formal diagnostic classifications. There have been significant changes to the classification systems for SUDs and MHCs with the advent of the DSM-5 (Kopak et al, 2014a; Kopak et al, 2014b), leaving a noticeable gap in the knowledge related specifically to the presentation of these conditions among adults in local jails. Most local detention centers are also situated in semi-urban or rural areas, and they tend to lack the highly trained clinical staff who are capable of performing these diagnostic interviews (Applegate & Sitren, 2008).…”

Substance Use Disorder, Bail Reform, and Failure to Appear in Court: Results From a Naturalistic Study

“…Following completion of the structured interview, participants’ responses were coded according to the diagnostic system for DSM-5 substance use disorders. This approach involves the assessment of 11 criteria to provide three designations: ‘mild,’ ‘moderate,’ and ‘severe.’ Respondents who endorsed two or three criteria were categorized with a mild substance use disorder, those with four or five positive criteria fell into the moderate category, and those with six or more positive criteria were diagnosed with a severe condition (Kopak, Proctor, & Hoffmann, 2014). Evidence of internal consistency of the items comprising the various condition-specific scales was obtained in the current study sample with Cronbach’s alpha values ranging from .94 to above .98 depending on the particular substance-related set of diagnostic items.…”

Alkoholio vartojimo ir priklausomybės nuo alkoholio sąvokų apibrėžties problematika : socialinės dimensijos įtrauktiems aspektas

“…C. S. Martin et al (2014) kvestionuoja vartojimo sutrikimų diagnostiką teigdami, kad negatyvios psichosocialinės ir sveikatos pasekmės turėtų vaidinti mažesnį vaidmenį. Tuo tarpu kiti autoriai mano, kad tai progresyvus žingsnis (Kopak, Proctor, Hoffmann 2014). Vis dėlto akivaizdu, kad socialinės dimensijos pripažinimas analizės kryptį fokusuoja ne tiek į pačią ligą, kiek į alkoholio vartojimą, alkoholio vartojimo pasekmes, tokias kaip žala pirminiams socialiniams ryšiams (šeimai), žala platesniam socialiniam kontekstui, kurį galima sieti su prievarta ir net žala ekonomikai (Klingemann, Gmel 2001), taip pat į socialinius, kultūrinius faktorius, skatinančius ir ribojančius alkoholio vartojimą (Martinic, Measham 2008).…”