DSM-5 Changes in the Diagnosis of Addictions

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Out with the old diagnostic manual, the DSM-IV, and in with the new.

The latest revision to the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, includes several changes to the criteria for diagnosing substance-related and addictive disorders.

DSM-5 Gambling Disorder

One interesting change in the DSM-5 is the inclusion of gambling disorder in the new category of behavioral addictions. Pathological gambling was listed in a different section of the previous manual, but research indicates it belongs in the substance and addictive disorders chapter, despite being a non-substance addiction.

What qualifies gambling for its new home in the DSM-5? Gambling is a disorder of the brain’s reward system as are substance addictions. During brain-imaging studies, the same brain areas are activated in response to cues for either gambling or substance addictions, indicating they share the same neurocircuitry.

Internet gaming, though not given the status of an official diagnosis, will be listed in Section III of the DSM-5. Section III lists unofficial disorders that require more research before being accepted as APA-recognized diagnoses.

DSM-5 Substance Use Disorder

Substance use disorder is a combination of the two DSM-IV categories of substance abuse and substance dependence. This new category measures an individual’s symptoms on a mild to severe continuum.

  1. Substances are each specified as separate disorders, such as stimulant use disorder or alcohol use disorder (caffeine use is not included in DSM-5 as a disorder).
  2. All substance disorder diagnoses are made using the same 11 criteria or indicators.
  3. Drug craving has been added as one of the 11 criteria, and the DSM-IV criterion of problems with law enforcement is eliminated from the DSM-5.
  4. Severity of disorder is determined by the number of criteria that apply to an individual. Two or three criteria indicate a mild disorder; four to five a moderate disorder; and six or more a severe one. At least two criteria are necessary for a diagnosis; in the DSM-IV, only one was required.

In the DSM-5, the words “dependence” and “abuse” are no longer used to indicate separate problems. One reason is that dependence can occur as a normal reaction to some medications or substances where their effect decreases with use over time. Also, the current thinking about dependence, abuse and addiction is that they are “one continuous variable.”

Other DSM-5 Changes

  1. Cannabis withdrawal is listed as a new diagnosis.
  2. Caffeine withdrawal is listed as a new diagnosis.
  3. Early remission from a substance use disorder is defined as at least three but fewer than 12 months without meeting the disorder’s criteria (except for craving).
  4. Sustained remission is defined as at least 12 months without meeting the disorder’s criteria (except for craving).
  5. Two new specifiers are “in a controlled environment” and “on maintenance therapy.” (Specifiers are used to clarify or expand on applicable criteria.)
  6. The specifier indicating a physiological subtype has been eliminated.
  7. The diagnosis of polysubstance dependence has been eliminated.
    1. Source: Psychiatric News

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