DSM-V: improvements, but also traps

[Olm the Water King]

I've already mentioned that they've removed the multiaxial system ( The Professional Counselor » The Removal of the Multiaxial System in the DSM-5: Implications and Practice Suggestions for Counselors ).

There have been other changes as well. I think the autism spectrum changes have also been talked about.

Then there are changes regarding substance problems:

https://www.thefix.com/content/DSM-V-new-definition-addiction-dependence-abuse8010

Scientists Unveil a Bold New Definition of Addiction

By Maia Szalavitz 02/09/12

The official diagnosis for addiction is getting a major makeover—promising major changes for the addiction community and healthcare professionals alike. Here's what you need to know.

To both "abuse" and "dependence," I say, “Good riddance.” Substance abuse—which was used to characterize drug problems that fall short of outright addiction, like college binge drinking—is a highly stigmatizing and misleading term. If “child abuse” means harming a child, does "drug abuse" mean harming a drug? It never made any sense linguistically and only served to associate drug users with abusive people in the public mind. Indeed, one randomized controlled trial showed that healthcare professionals who read vignettes about patients described as "substance abusers" supported more punishment and less therapy than those who read about the same patients identified as having "substance use disorders."

Even worse is “substance dependence.” The term was placed into a revision of the third edition of the DSM, DSM III-R, in the '80s as a euphemism for addiction with the intention of using a “medical sounding,” or nonstigmatizing, phrase...

Now the problems:

https://www.thefix.com/content/addiction-definition-phony-epidemic-DSMV8765

Basically, there are 11 criteria for 'substance use disorder', 2 of which need to be met for a diagnosis. If 2 or 3 are present, the disorder is 'mild', if 4 or 5, it's 'moderate', anything more than that is 'severe'.

The problem...

The problem, of course, is that those ideas will be set free into a world in which the National Institute on Drug Abuse, the American Society of Addiction Medicine and the millions of members of 12-step programs define addiction as a “chronic, relapsing disease.”

All of these groups and, most importantly, the addiction treatment industry, tend to see everyone who takes a lot of drugs or drinks heavily at any point in time as having that disease. Some even diagnose any use of illegal drugs at all as addiction. This, not coincidentally, is in the economic interest of a quickly mushrooming rehab industry. In fact, in the '80s, major chains of rehabs and psychiatric hospitals had to pay out big settlements in lawsuits over admissions of people who did not have the diagnoses the programs claimed (some were children kidnapped and held till their insurance ran out).

...This push to adopt an addict identity happens even in adolescent treatment— despite the fact that most teens in treatment do not meet criteria for being addicted (some don’t even meet criteria for drug abuse!). Indeed, the vast majority are, not surprisingly, nondaily binge users of booze and pot. Nonetheless, at ever-younger ages, these kids are being pressured to view themselves primarily as addicts and alcoholics and to admit to having a chronic, lifelong illness with a 90% chance of relapse. Very little research has been done on the effects of this “treatment”—but given what we know about the fluidity of adolescent identity, it certainly has the potential to do significant harm. For one, it can be a self-fulfilling prophecy...

P.S.: Note that according to that criteria, up to 40% (!) of all college students could easily be considered as having some kind of 'substance use disorder' at any time: DSM-5 Could Categorize 40% of College Students as Alcoholics | TIME.com

Also, I haven't gotten into the issue of "dependence" yet. It's interesting too. Luckily, they've gotten rid of that.

 

[Olm the Water King]

Relevant:

Addiction as self-fulfilling prophecy?

Jeffrey A. Schaler, Ph.D.:

"This relationship between belief and behavior is known as a self-fulfilling prophecy. The more people believe in their ability to moderate their consumption of drugs and alcohol, the more likely they will moderate. The inverse is true too: The more people believe in their inability to moderate their consumption of drugs and alcohol, the more likely they will not moderate."

Warburton, Turnbull, Hough:

"We have described a group of heroin users who fail to fit in with popular conceptions about the drug, for example that heroin use inevitably leads to dependent and destructive patterns of use. Below we reflect on the differences between the users in our samples and this popular assumption. In doing so, we suggest that dependence is - at least in part - socially constructed. That is, the expectation and belief that heroin is uncontrollable lead individuals to use the drug in this way. We raise the possibility that a clearer popular understanding about heroin use might ultimately bring about a reduction in problem use."

Jeffrey A. Schaler, Ph.D.

https://www.jrf.org.uk/…/…/jrf/migrated/files/1859354254.pdf

 

[Olm the Water King]

The role of the media in all this (both entertainment and "serious"):

As for entertainment, I don't think I need to go into it...Anything from films that are seen as crappy to films like Traffic, Requiem for a Dream that are not seen as crappy (even though they are).

Then there's "serious":

The New York Times Is Hooked on "Drug du Jour" Journalism - Substance.com

The New York Times Is Hooked on “Drug du Jour” Journalism

For the paper of record, addiction is always about this drug or that drug rather than the real causes...

The stories we tell ourselves matter: As Joan Didion memorably put it, “We tell ourselves stories in order to live.” But journalists have a special responsibility because the way we frame our narratives doesn’t only affect us—it can influence readers and public policy. And the story we are telling about drugs isn’t working...

There is strong reason to believe that a lot of harm could be reduced if drugs were seen more realistically in the popular imagination.

https://www.thefix.com/content/harm-benefits-drug-war-abstinence8509

Exaggerating the Risk of Drugs Harms Us All

... Alcohol, cocaine and heroin have a 3% to 15% rate of addiction, depending on how it is measured...

...I mention these facts not to promote drug use. That I feel compelled to immediately include such a disclaimer underlines my point: Our values shape our perception of risk and the way we make drug policy. If we recognize only the risks and ignore the benefits, we fail to understand that the real problems are addiction and harm—not the substances themselves and the people who use them.

For instance, when we talk about the “epidemics” of Oxycontin, methamphetamine or heroin, we rarely acknowledge that the majority of users never become addicted: Over the course of a lifetime, only about 10% to 15% ever get hooked. That risk is not insignificant: Few people would fly on a plane that crashed every tenth flight. But focusing on use as the main factor in addiction obscures what is actually at stake...

 

[AphroditeGoneAwry]

I have never liked the psychology behind 12 step programs in that they teach people in their lowest moments of life that they are powerless to a certain substance, and cannot control it, never will be able to control it, and even have genes that will keep them from being able to control it. How could anyone ever live a healthy life in that defeatest mindset?

On the other hand, those in denial to their addiction NEED a 12 step programs, or at least ongoing introspection and counseling about their problem or addiction.

I like the changes. I don't qualify for any of them currently, so I guess I'm okay. Recently my son, who is seeing a therapist, told me, "I guess I have some addictive personality like you and dad." And I was like WOAH THERE! I don't have an addictive personality. Therapy, again, planting false ideas in someone's brain.

How can we as a society think that a stranger who sees us once a week or once every two weeks for about an hour each time can treat us effectively, and not make false assumptions to fill in gaps in their knowledge of the patient which must necessarily exist???

I'm starting to think of therapists with about as much respect as I have for physicians in general.

 

[Olm the Water King]

And some interesting stuff on 'Somatic Symptom Disorder': Terrible News: DSM-5 Refuses to Reduce Overdiagnosis of 'Somatic Symptom Disorder'

A site full of criticism (including by dr. Allen Frances, one of the lead authors of DSM-IV): DSM-5 Sucks

Lance M. Dodes, M.D.: https://www.thefix.com/content/addiction-DSM-5-diagnosis-brain-disease-compulsion8091

Stanton Peele, Ph.D., J.D.: The Future of Addiction: My Predictions for the Next 40 Years - Substance.com

Allen Frances, M.D. (one of the authors of DSM-IV): https://www.psychologytoday.com/blo...-guide-not-bible-ignore-its-ten-worst-changes

DSM 5 Is Guide Not Bible—Ignore Its Ten Worst Changes

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