As I mentioned in my previous post on diagnostic categories, the next edition of the Diagnostic Statistics Manual (DSM5) of Mental Disorders will significantly change diagnoses related to alcohol and drugs. No longer will the diagnosis of abuse exist, but instead we will have one category or diagnosis of problematic substance use behavior with varying degrees of severity. At issue is what to call this disorder.
Presently, the term addiction does not appear anywhere in the DSM, but instead the term dependence is used to describe behavior that traditionally invovles compulsive use, loss of control, and continued use despite consequences.
Unfortunately, the term also describes a normal process that has nothing to do with problematic behavior or addiction, such as a person who becomes “dependent” on insulin for diabetes, or pain medicines for chronic pain. In these instances, the term dependence describes something entirely different than what is in the DSM.
What to do?
It sounds likely that the upcoming new version of the DSM will use the term addiction and drop dependence because of its dual meaning. Other terms including appetitive disorders have been thrown around, but this label would require significant public education.
Those who are against using the term addiction say:
- It carries too much stigma
- Has no clear scientific definition
- Overly identified with drug abuse instead of the full range of excessive behavioral problems
(e.g., sex, food, gambling)
In truth, there is no perfect term, but at least addiction is a commonly used term that most understand, even if it presently is not associated with a universally agreed upon definition.
I support using the term, but also believe the field needs to evolve its thinking and define addiction more broadly to include the full range of problematic behaviors that go beyond just drugs and alcohol.
At CPDD speakers suggested gambling will be included in the new diagnosis, and potentially internet addiction in the near future, but sex and food – perhaps the two most powerful addictions due to their link with our survival – will likely not make the cut.
What this means
It means that politics win over science and many folks who need help will not receive it because insurance companies will have a reason not to pay for something if it is not officially in the DSM and/or does not have the right diagnostic codes.
I believe that addiction is the best term to use. It is associated with ATOD, and is commonly used in organizations, clinics and communities. It is sad to here that the politics behind this will unfortunately limit the addiction term, and keep out food, and sex. I hope that in the near future policy makers will see the benefit to adding these addictions to the list.
Cindy E says
I agree that the term addiction is the most known definition for the abuse of drugs. I am in favor of taking the politics out of a subject that is scientific, medical and behavioral. Insurance companies need to get on board and provide services to the customers that they are paid for and the only way to get around the hang-ups is to not get political.
Melissa Walker says
I’m going to have to agree on addiction. I have a husband with a severe problem with addiction and there is so much information floating around. Much of this information addresses addiction as if walking on eggshells. Addiction is a serious problem and it must be addressed head-on. My family is being torn apart by this problem and there is so much that a person has to go through in order to have this addressed as a true problem and not just a personal choice.
An addiction affects every aspect of a persons life and should be seen as an incredibly important and potentially catastrophic problem.
I too support that we should just call addiction an addiction. Again, it is really frustrating when science which can be tested, measured, and is valid can be disregarded? With sex & food being major categories in addiction they should definitely be in the addictions category. To not include them would be a problem. I think a lot of it has to do w/society and what has been adopted under the addictions category…because of politics we don’t look at the criteria for addiction we look at the object, and that doesn’t bring about resolution. I am very weary about what the new DSM will bring as I think it is difficult enough to inform clients, but to deal w/the DSM errors or what not and that is supposed to be a good reference tool for me as a counselor? That’s a bit scary
David P says
Semantics. It is in so many ways a game of semantics. I know that proper diagnosis is important to treating and disease or disorder. The irony for me is that those who do not have addiction or disorder make the decision on what to call it. In AA, it is called the “ISUM”. I have called the ick or addiction. I live with it every day and I don’t know what is proper. It just seems very strange for them to be changing its designation in the DSM V. I wonder how much time went into it. I mean how much time did these very bright and intelligent people spend not treating someone or not making someone’s life better, but worrying what to call what it is we have.
I wonder how many meetings or discussions or email or phone calls and debates and how much money was spent on deciding what to call a disease that has been around since time started being counted. I very much appreciate that those esteemed experts chose to even care enough about addictions to worry about what to call it or how it should be labeled in the DSM. But, really? How about finding different ways to treat it? How about a nicer approach for dealing with those afflicted with this disease? How about finding something different than locking up drug addicts for having the disease or disorder? I have been to state prison. It is really more like 90% have drug crimes or 9 out of 10 are they due to drugs and alcohol.
In closing, again I want to say how grateful I am that those very important people care enough to even argue about what to call the disease/disorder of addiction. In fact, I am very grateful to anyone who gives there life’s blood to the treatment of addicts. It is very hard and complicated–not everyone can or wants to do it. People die and they seem to only want to do damage to themselves. It is heartbreaking work. Many thanks, some of you professionals saved my life. Just the idea that I had a disease that it was treatable and that I wasn’t so damaged that society could not forgive me was enough for me to begin the journey of my recovery.
Katie Lynett says
I also agree that addiction is the best term to use for this phenomena. I believe that it is important to remove the “object of addiction” from the “relationship of addiction”. I know that I have talked about this in comments on this blog before, but I have really become interested and moved by the idea that ” addiction is an adaptive relationship with an object instead of healthy relationships with people”. This really emphasizes that it is not about the object and any object can be addictive if the person with addiction develops that relationship with object. If more people though about addiction this way, then I think the way we catergorize it would become less important.
However, one other thing struck me while reading your discussion about dependence and how it has other more neutral meaning such as being dependent on insulin if you are a diabetic. The example of a person with chronic pain using opiates to manage the pain struck me. One of my interests is working with people with chronic pain and when doing research I learned that most people with chronic pain do not become addicted to their narcotic medication. However, some doctors are so fearful of that they won’t give people the medicine they need. If you think about addiction in the relationship context, people are not likely to develop an addiction if they are using it for its intended physical purpose and they have real human relationships in their lives.
Brittiana M says
I too believe and support that addiction is the best term to use for addiction. I feel that it is the most common term associated and used with clinics and organizations such as AA and other various support groups. I appreciated the above post mentioning the power of semantics. I find it silly that the term has become limited and leaves out tons of other addictions and issues. With sex & food being major categories in addiction, they should definitely be in the addictions category.
Keri Nielsen says
When reading this, it made me think of how we all categorize and define addiction itself. If we are in need of something to survive does that make it an addiction, like mentioned above for example food or sex? Are we also addicted to water since we NEED it to survive? I do think addiction is the best word to describe what it means. “In truth, there is no perfect term, but at least addiction is a commonly used term that most understand, even if it presently is not associated with a universally agreed upon definition” >>This is definitely true! We all know what it means when we talk about addiction and we all have a common understanding as well so it is a perfect term to describe itself. I remember reading about how dependence can have different meanings in different cultures and to different people so addiction is a better term and has more of a solid stable meaning that most can relate to and understand. It is more blunt as well. In mu opinion, abuse LEADS to addiction.
I realize that I am responding to a blog post that was drafted several years ago when revisions for the DSM IV-TR were just beginning. In response to an article in the New York Times, the APA made several corrections to supposition made by the article’s author, Ian Urbina. Of particular interest was the APA’s response to the potential for barriers to treatment:
Many individuals with substance use disorders would have only a mild problem as they do under the current diagnostic criteria. Those with both mild and severe substance use problems have had great difficulty in obtaining adequate services in the present health care system and it would be health care reform and not the diagnostic criteria that would make the most difference in increasing access to care. The characterization of the severity levels for these conditions, rather than the current artificial distinction between abuse and dependence, has the potential to better guide the type and intensity of prevention and treatment services.
Regardless of what clinical jargon we choose to use to reference the concept of addiction, I think the new classification system also addresses issues of best practice for practitioners. Individuals suffering from a substance related disorder would be better served if their treatment (rather than a clinical term) were tailored to their needs.
Accessed 04/13/2013 at 18:10