This past week I attended the 71st Annual Scientific Meeting of the College on Problems of Drug Dependence in Reno, Nevada. As usual, many of the world’s leading addiction scientists attended the conference to bat around the latest ideas in the field.
One of the most memorable sessions for me was focused on the work group responsible for alcohol and drug diagnostic categories in the upcoming new edition of the Diagnostic Statistics Manual (DSM5) of Mental Disorders.
Presently, problems with alcohol and drugs fall into two general diagnostic categories – abuse and dependence. It turns out that these categories are largely the product of researchers sitting around a table and theorizing, and not so much on sound science.
Substantial data now suggests that these categories do not represent distinct diagnoses, but instead should be combined to reflect a unidimensional continuum of substance-problem severity.
In technical terms, factor analysis revealed they load on the same factor and using Item Response Theory suggests the curves all stack on top of each other.
What does this mean?
In the new DSM5 there will be no “abuse diagnosis” and only one diagnostic category with varying degrees of severity. This brings up the loaded topic of what we call this category – an issue I will write about in my next post on what addiction is. But for now, I want to conclude on three points:
Labels have power, and for years while doing clinical work I labeled folks as having abuse/dependence diagnoses. For many clients these labels took on great meaning – both positive and negative – and may continue to influence their life today.
Now I learn that my labeling was likely incorrect at times, and it teaches me that perhaps we need to not forget that labels are socially constructed, even when influenced by science.
What we label as a disorder may be entirely normal in another culture or time.
We diagnose and label people largely because of politics and money. Diagnoses determine what insurance will pay for, who gets treatment, what gets researched, and how as a society we want to understand and talk about specific problems.
Diagnoses, labels, and categories of behavior are beneficial when they link to specific interventions that have been shown to be scientifically valid.
For more details on this issue, see: How should we revise diagnostic criteria for substance use disorders in the DSM-V