Others are more concerned, arguing that abuse should be thought of as a behavior and dependence as a disease, and by combining them it becomes easier for payers to deny clinically appropriate care. Even worse, it might signal a shift to the idea that any professional with "behavioral" health training would be eligible.It's worth noting that is not an argument for the status quo. I've never been comfortable with abuse as a disorder.
Sunday, April 18, 2010
More concerns about DSM-V criteria
This concern speaks to some of my thoughts.
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5 comments:
I don't pay a huge amount of attention to DSM-V criteria, simply because it's about putting a name to things that are vague and blend together and are by nature hard to pin down with specific terminology. And because luckily I'm not in the health care or treatment business and don't have to put a name and billing number on anything.
Trying to cleave a useful line between "dependency" and "abuse" is always going to be tough. I generally just use the term "addiction," but of course that term has been stretched until it covers almost anything.
DSM-V-bashing is a long-standing tradition, but I say give 'em a break, it's an impossible task.
Thanks for the comment. I'm more or less with you.
When I'm educating people about assessment and diagnosis I tend to characterize people with addiction as having lost the ability to make good decisions about drug and alcohol use whereas "abusers" are people who are making poor choices related to alcohol and drugs.
I guess I just don't see a need for those people in the second category to be characterized as having a disorder. However, I tend to be pretty conservative diagnostically. I have the same quarrel with clinicians and researchers who are comfortable diagnosing grieving people with major depression.
I think part of my reluctance is my experience of most helping systems doing a very poor job of periodically reevaluating diagnoses.
Couldn't agree with you more about the low hurdles for major depression. And you are also correct that some manner of nomenclature has to be worked out so that addiction treatment people spend their time with addicted individuals, rather than with people who are choosing to use drugs unwisely. Addict vs abusers works for me--but then what about "dependency"? Now there's a catch-all term that seems to defy any kind of solid definition.
Interestingly, in a recent conference call with NIDA's Nora Volkow, I discovered that she was in favor of eliminating the term "dependence" from the DSM-V. Her feeling was, you can't equate physical dependence automatically with addiction--and in fact when you do, you make people scared to take opiates for intractable pain, for example.
Physicians have complained about the term dependence for years because pain patients can be physically dependent upon opiates--they develop tolerance and withdrawal-- but are not addicts.
If their pain is under-treated, they'll sometimes develop drug seeking behavior that can lead to professionals labeling them as addicts. Interestingly, the way to tell whether they're an addict is to give them more opiates. If the drug seeking stops, they're probably not an addict.
I'm pretty sympathetic to these concerns about the term and would prefer "addiction".
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