The DSM and Addiction: Why Addiction Terminology Matters

Since this is a blog on “Addiction” I thought it would be important to discuss the diagnostic criteria and terminology the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) uses, because the current manual does not include the word “addiction.” The current manual uses substance abuse and substance dependence. For the definitions and criteria on what substance abuse and dependence is see here.

DSM-IV: Substance Abuse vs. Addiction

The current DSM-IV section for abuse and dependence is called “Substance-Related Disorders” and does not use the word “addiction. The new DSM-V (which is currently in the works) now has a new tentative title “Addiction and Related Disorders.” For a long time there have been debates on what is addiction, and in a lot of writings people use the term substance dependence as interchangeable with addiction. A lot of people say there are very different definitions of substance dependence and that of addiction.
My story also includes eating disorders, self harm, and anxiety disorders. I know when I was seeking treatment they used the “substance dependence” box versus the eating disorder box, to help get me approved for treatment. The DSM is important to understand when we are talking about addiction, because it impacts how people are labeled, helps us understand stigmas placed on people, and impacts treatment and level of care.

This is why people are trying so hard to work on changing terminology used because it is really important in the studies and clinical care of people who are struggling from these issues.

The DSM-V will re-introduce the word “Addiction”

I think it will be interesting to see how the DSM-V is changed, because in its proposal they are looking to limit the word dependence to physiological dependence rather than a label for addiction. The argument is that physiological dependence is a normal response of the central nervous system to that of a substance versus a compulsive substance seeking behavior that is common in addiction.

Another of the issues is the concepts of tolerance and withdrawal, because those who have pain management issues, may experience tolerance and withdrawal, but not be compulsive in behavior, and this presence of tolerance and withdrawal adds to the stigma of those who require medication for pain management.

The word “addiction” helps better encompass the chronic, compulsive and relapsing nature of continued substance abuse, despite negative consequences experienced over and over.

You might be asking – why are you writing a post on terminology so readily used surrounding addiction?

I wanted to delve into the topic of terminology because it is important to understand the diagnostic criteria of what makes something abuse or dependence in the current DSM manual. The DSM is the common language for current study and practice, and while it is evolving into a new manual, these terms will pave the way for future research and clinical practice. It provides a standardized approach to diagnosis and psychology.

The terms also matter because when a person is seeking treatment for a struggle, with abuse, dependence or addiction, there will be a criteria used to determine the best possible treatment care (including evidenced based care that has been shown in research as an effective treatment methodology), but also plays into health insurance coverage for care.

When we talk about issues we need to know what the terms are, and how they affect diagnosis, treatment, and societal impressions of disorders. Addictive behavior and its study cross so many lines and disciplines, including but not limited to pharmacology, sociology, neuroscience, genetics and biology. The terminology needs to be consistent and clear, especially since we are seeing more and more emphasis on multidisciplinary research and treatment approaches.

The constant refining of these terms helps researchers (as well as clinicians) better understand the use, abuse, dependence and addiction of behaviors and substances in order to help develop better methods in diagnosing and treating co-mordid conditions.

Co-Morbidities and Addictions

When I was looking for treatment, I had eating disorders, alcohol abuse/dependence, self harm, panic disorder and GAD. Trying to find a place where they would take me was a challenge for my parents. At the time, there were specialized treatment places, but they wouldn't be able to treat all of my struggles. We need to discuss co-morbidities more and understand that the terminology matters. A multidisciplinary approach will provide a better (and more inclusive) treatment option for many struggling more than one diagnosis, like me.

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