The Impact of the Proposed Changes for the DSM-5 on Diagnoses of First-time DUI/DWI Offenders

Abstract

Driving while impaired (DWI) is a frequently committed crime with enormous individual and social costs. The type of disposition and/or treatment appropriate for an individual offender is often determined, in part, by diagnostic criteria based on the American Psychiatric Association's Diagnostic and Statistics Manual. The DSM-5 significantly modified these criteria by eliminating legal problems as a criterion and dropping the categories of abuse and dependence. A brief substance abuse focused interview was conducted with 658 consecutive first-time DUI offenders who were arrested for driving under the influence of alcohol. Most were white, well-educated males. Contingency analyses were utilized to compare the current with the new diagnostic criteria based on algorithms for both diagnostic formulations. The major change observed when moving from DSM-IV-TR to DSM-5 criteria was that, approximately 54% of first-time DUI/DWI offenders would no longer meet diagnostic criteria based on the DSM-5. Of the nearly 17% who met dependence criteria, the majority were in the severe designation of the DSM-5.

The prevalence of substance use disorders among community-based adults with legal problems in the U.S

“…The treatment of AUD among people in the justice system is especially important to consider with the removal of legal problems as one of the criteria used to diagnose disordered substance use in DSM-5. For instance, one study found that people with initial DWI offenses met criteria for substance abuse using DSM-IV-TR criteria but were no longer diagnosed with an AUD using DSM-5 criteria (Baley & Hoffman, 2015). Despite research consistently showing that AUD is highly prevalent among people involved in the criminal justice system, people arrested for DWI are often incarcerated for brief periods and/or referred to educational classes rather than substance use treatment.…”

The impact of DSM classification changes on the prevalence of alcohol use disorder and ‘diagnostic orphans’ in Lebanese college youth: Implications for epidemiological research, health practice, and policy

“…One concern is that DSM-5 AUD classification might miss young people in high-risk groups, such as repeat DUI offenders, that DSM-IV alcohol abuse would have captured, which may result in fewer people receiving any attention or care for their recidivism. Targeted educational programs or other community prevention programs may not suffice for this group of recidivists [57]. While DOs would need early detection and management, population-based and evidence-informed public health prevention measures and adequately enforced legislations such as tighter drink-driving regulations remain key for preventing DUI [58,59], and reducing the risk of "over-pathologizing" human behaviors [60].…”

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

“…A study of first-time driving under the influence (DUI)/driving while intoxicated (DWI) offenders found that a significant portion of these cases acknowledged only driving under the influence (reflective of the DSM-IV criterion related to use in dangerous situations) and the legal problem of being arrested [22]. With the DSM-IV, these cases would have received an abuse diagnosis, but will not receive a diagnosis with the DSM-5.…”