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What’s in a name? That’s a question that experts are wrestling with as they prepare to revise the diagnostic manual that spells out the criteria for addiction and other substance-use problems.
The catalyst for this discussion is a set of proposed changes to the Diagnostic and Statistical Manual of Mental Disorders, the reference guide upon which clinicians, researchers, insurers and others rely to identify and classify psychiatric disorders. The revised guide, called DSM-5, will incorporate changes to more than a dozen categories of disorders, including those related to mood, eating and personality, as well as substance use and addiction.
Developed under the auspices of the American Psychiatric Association, the revised manual is scheduled for release in May 2013.
The new guidelines would do away with the diagnostic categories of “substance abuse,” which generally is defined by such short-term problems as driving drunk, and “substance dependence,” which is chronic and marked by tolerance or withdrawal. They would be replaced by a combined “substance use and addictive disorders” category.
They would also, for the most part, merge the criteria used to diagnose disorders related to the use of alcohol, cigarettes, illicit or prescription drugs and other substances into a single 11-item list of problems typically associated with these disorders. The list covers issues such as being unable to cut down or control the use of that substance and failing to meet obligations at work, school or home.
People would be given a diagnosis based on how many criteria on that list they met: no disorder (0-1), mild disorder (2-3), moderate (4-5) or severe (6 or more).
Supporters say the proposed changes, by creating a category for mild disorders, may make it easier to identify and address drug or alcohol problems before they become serious, as well as helping people to access services they need as the new DSM guidelines might make it easier for primary-care doctors to be reimbursed by insurers for screening for alcohol and drug problems and conducting short counseling sessions that have been shown to be effective.
Because the new guidelines use a single spectrum for substance use and addictive disorders, some addiction experts worry that, for example, adolescents who meet the criteria for mild substance use because they’ve engaged in binge drinking and missed classes because of it within the past 12 months — thereby earning a score of 2 — might be labeled as having a mild addictive disorder, which in many cases would not be accurate. Others may see this an important early warning flag.
Even though the Mental Health Parity and Addiction Equity Act of 2008 requires insurers to cover mental and physical health services equally, “people still have to fight for addiction treatment,” says Marvin Seppala, chief medical officer at Hazelden, a Minnesota nonprofit that runs drug and alcohol treatment centers around the country.
This week on twitter, spectators in Europe have been hoping that the new classification may lead to easier access to treatment and rehabilitation services.
Source: The Washington Post.
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