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Revised Definition of Addiction Could Lead to Millions More Being Diagnosed

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A proposed revision to the definition of addiction by mental health specialists could lead to millions of additional people receiving an addiction diagnosis, The New York Times reports. The changes could lead to big consequences for both health insurers and taxpayers, according to the newspaper.

The revisions are being proposed for the new edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), scheduled for release in May 2013. The manual would enlarge the list of recognized symptoms for drug and alcohol addiction, and reduce the number of symptoms needed for a diagnosis.

The new manual would include gambling as an addiction for the first time, and may introduce a category called “behavioral addiction—not otherwise specified,” that some public health experts say might be used too often to diagnose various addictions, including shopping, video games, sex or the Internet.

The DSM is important because it determines whether insurers, including Medicare and Medicaid, will pay for treatment, and whether schools will finance specific special-education services. The court system uses the DSM to evaluate whether criminal defendants are mentally impaired. Drug manufacturers rely on the manual when making decisions about research.

Some economists predict the new definition of addiction could add 20 million people, leading to additional costs running into the hundreds of millions of dollars.

“The chances of getting a diagnosis are going to be much greater, and this will artificially inflate the statistics considerably,” Thomas F. Babor, an editor of the journal Addiction, told the newspaper. He said many people receiving a diagnosis of addiction under the new guidelines would have only a mild problem, siphoning off scarce drug treatment resources in schools, prisons and health care settings.

While the American Psychiatric Association scientific review panel has asked for more evidence to support the revisions on addiction, several researchers involved with the manual noted the panel is unlikely to significantly alter the proposed revisions.

12 Responses to this article

  1. linda holden / July 10, 2012 at 8:48 pm

    My opininion is that unless you meet the DSM requirements then you need not worry about getting diagnosed prematurely, and on the other hand there were alot of people that were not meeting the requirements and not getting treatment. Look at the statistics. On average 20 years for an alcoholic to get treatment for the first time and 7 years for a drug addict. Come on where is their life? What about their families! Look at the out comes. Patterns are being set and society is failing to help individuals. Nobody wants to be addicted. It is a disease . Get it.

  2. Avatar of Pernilla Burke
    Pernilla Burke / June 26, 2012 at 1:07 am

    what scares me the most about this is that those with serious addictions, like kevin says crack cocaine, her ion etc will they get lost in this? the level of severity of addiction comes into play. also, i wonder how we ended up here…why are we all so addicted? what happened that we now need to change our description of addiction to encompass a broader picture. there is a lack of connection with self and spirituality that really worries me.
    also, i disagree with rosi that kids do drugs cause they are bored. the issue is so much more complex than that. kids these days are over scheduled with activities and yet they seems to just want to get out of themselves….i never did drugs because i was bored, it started with curiosity and a combination that things were tense at home. i felt an intense lack of purpose and meaning. now that i am clean 14 years and have my own two small children i try to teach them meaning and values and the beauty of life in hopes that they won’t go down the same road as i did.

  3. Avatar of Rosi
    Rosi / June 5, 2012 at 5:15 am

    was a drug addict myslef, i know what actually causes it, and i know how to prevent it.the best thing is actually comfortable and love in family. Rules or forcing would actually tempted them to try. Keeping them busy like exercising (together with them) does help alot. out door activity such as BBQ party and surfing at the sea is a great way to take their focus out of drugs and alcohol.kids do drug because they are bored, just remember this.

  4. Badger / May 21, 2012 at 12:24 pm

    They are not looking at the 18-24 year old binge drinkers that once they mature, they become responsible drinkers. This will have a very negative impact on that population, more so than the 26-30′s+ population that don’t learn to make the behavioral change on their own. If this is to raise individuals bottoms, then there will be more mis-diagnosed folks that are rightfully so, not going to buy-in to any form of treatment and will have a negative stigma about treatment. If/when they do end up needing treatment at a later date, they will already have a jaded perspective of it. Most go into it kicking and screamiing anyway; but if they do have the disease, they eventually may get it. I see an issue diagnosing the early misusers as something more than what they are. I believe that early intervention has it’s place, but not in the DSM. That is for the Health Promotion/Education providers in the schools and Public Health. Not as a guide line for diagnosing, which the DSM is; a guide line for making a diagnosis.

  5. Avatar of Kevin
    Kevin / May 20, 2012 at 2:43 pm

    There is something deeply unsettling about the current fad and attachment of big business lobby groups and their promotions of anti-autonomy. Even within this article we see a definite mood being portrayed, that it is Politicians, Public Health groups, the charities or the medical institutions who have the last say over other people’s bodies and behaviors. Nothing could be further from the truth. Autonomy laws were necessary to defeat the eugenics movement and to criminalize the Fascist “protections” mantra [the nanny state]so popular among medical institutions only 60 years ago. People need to get interested in what is important here; your immediate problem solving and convenience or your immutable rights, to have the final say. If picking your nose may now be determined to be an addiction, how powerful will the term encompass the situation where someone has a physical and emotional attachment to Speed or Crack cocaine? Habits are not addiction they are simply repetitive and at times annoying. The English language and the medical sphere needs a word with a noncontroversial legal meaning. Tinkering to emphasize lobby positioning and the emotional drama they will use to sell their wares, is no good reason for undermining parental and personal autonomy rights. Think long and hard on your positioning here because rights are so easily lost and usually require bloodshed to regain.

  6. Jose G. Carreon / May 15, 2012 at 11:50 pm

    People, please.
    The sky is not falling. If you meet DSM-V criteria for Substance Use Disorder does not necesary mean that your meet the soon to be outdated DSM-IV criteria for addiction. You could if you met at least four of the eleven criteria, as stated earlier. However, it would not automatically mean that you are going need inpatient treatment. That determination would depend on the clint placement critria that you meet using the ASAM patient placement criteria-2 (PPC-2). When used together, you will be placed on the lowest portal of care that would meet your needs. Using the DSM-V and the ASAM PPC-2 would also help you justify you client recomendation for insurance purposes.

  7. Julian / May 15, 2012 at 6:56 pm

    “many people receiving a diagnosis of addiction under the new guidelines would have only a mild problem, siphoning off scarce drug treatment resources in schools, prisons and health care settings.” This is a problem because??? Imagine treating people before they end up in prison or a health care system. Before their families are impacted by their increased drug or alcohol use. Before other people are impacted by their increased drug or alcohol use. TREAT ADDICTION. SAVE LIVES.

  8. Michael W. Shore, M.D. / May 14, 2012 at 1:58 pm

    This would not change the prevailing practice of insurers to quote “medical necessity” criteria (that they develop themselves) to deny necessary and appropriate intensity and duration of treatment. They are doing this already!!

  9. Mark Nason / May 14, 2012 at 12:41 pm

    The assumption that any level of severity of DSM-V “substance use disorder” diagnosis is the same as “addiction” is without basis. While under the section heading of “Substance Use and Addictive Disorders,” the DSM-IV abuse and dependence diagnoses are being replaced with “substance use disorder.” There are three levels of severity listed (http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=452#). “Mild” substance use disorder requires a minimum of 2 criteria, while “moderate” requires 4, and “severe” requires 6 criteria. What used to be “abuse” is probably closer to “mild” substance use disorder and what used to be”dependence” is probably typically at least “moderate” substance use disorder. What is the basis for the conclusion that millions more will receive a diagnosis? Under DSM-IV abuse, only one criterion was sufficient, and the four criteria included legal problems related to use. This criterion is not included in the proposed DSM-V criteria. So, yes, 2 of 11 criteria is less than the 3 required for DSM-IV dependence, but more than the one criterion needed for DSM-IV abuse; and since 4 criteria are required for “moderate substance use disorder,” the net affect is probably going to be similar to DSM-IV . So, again, what is the basis for these “the sky is falling” statements?

  10. Marcia Kirschbaum / June 16, 2012 at 12:43 pm

    Great post Kevin!

  11. Avatar of Ashraf
    Ashraf / July 15, 2012 at 2:42 pm

    I hate that word, chance.It has a super poivstie sound to it, but in English you use it like you use risk .It sounds like you want to be addicted. There’s a chance of getting addicted to liquor. There’s a risk of getting addicted to liquor. Or you could use likelihood for a more objective sound.

  12. Marcia Kirschbaum / June 16, 2012 at 1:08 pm

    Absolutely Rosi. There is not “treatment” required for most addictions other than massive understanding, patience, real-food-nutrition, exercise, sleep, hydration… ya know, the kind of things a body might be deficient in – certainly there is not drug deficiency in the body and addiction will never be cured or even helped by use of diagnosis and “treatment” usually with drugs involved. Certainly the emotional support of family and friends makes the journey easier, but with all the misinformation, that makes a drug addict the equivalent of a serial killer, the stigma and criminalization attached, we’ve certainly learned, not many can count on that support.

    I used coke for 3 years and quit easily just by getting busy with other thing and staying away from other users. 25 years later when one of my kids got addicted to pain killers after a surgery and it escalated to heroin, I got him clean with substantially more effort, though an organic diet, Nutraceuticals supplements, exercise, acupuncture and massage therapy. NO freaking drug switching. What IS the point of that madness, besides profit to the drug industry and all those under their wing? The mind set of this country, that drugs fix anything is mindboggling to comprehend. When are people going to figure out that the human body see synthetic chemicals as nothing more than one more huge problem to battle, in an already compromised and struggling body?

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