Recovery Machine Podcast

We look at the Diagnostics and Statistical Manual of Mental Disorders and discuss how the diagnostic criteria for substance use could be improved.

#DSM5 #drugaddiction #diagnosingaddiction

DSM-5-TR Substance Use Disorder Criteria:

A problematic pattern of use leading to clinically significant impairment or distress, as

manifested by at least two of the following, occurring within a 12 month period:

1.    Taking the substance in larger amounts or for longer than you're meant to

2.   Wanting to cut down or stop using the substance but not managing to

3.   Spending a lot of time getting, using, or recovering from use of the substance

4.   Cravings and urges to use the substance

5.   Not managing to do what you should at work, home, or school because of substance use

6.   Continuing to use, even when it causes problems in relationships

7.   Giving up important social, occupational, or recreational activities because of substance use

8.   Using substances again and again, even when it puts you in danger

9.   Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance

10.  Needing more of the substance to get the effect you want (tolerance)

11.  Development of withdrawal symptoms, which can be relieved by taking more of the substance

The 11 criteria outlined in the DSM-5-TR can be grouped into four primary categories: physical

dependence, risky use, social problems, and impaired control.

Severity of Substance Use Disorders:

The DSM-5-TR allows clinicians to specify how severe or how much of a problem the substance use disorder is, depending on how many symptoms are identified.

Mild: Two or three symptoms indicate a mild substance use disorder.

Moderate: Four or five symptoms indicate a moderate substance use disorder.

Severe: Six or more symptoms indicate a severe substance use disorder.

Problems with the DSM-5 criteria:

1.   It’s almost impossible not to qualify for a SUD.

2.  It doesn’t take into account autonomy or personal freedom.

3.  The criteria are exacerbated by current drug laws and policies. These are not relevant to medical issues.

4. It diagnoses chronic pain patients with a SUD. 

Suggestions as alternatives:

1.   Do you currently have concerns about your health or well-being related to drug use?

2. Is drug use making it difficult to achieve your goals?

3.  Is drug use causing you to self-isolate or making it harder to connect with people?

4. Have you tried to cut back on your drug of choice but found it difficult or impossible?

5. Are you currently physically dependent on a substance? In other words, would you suffer from withdrawal symptoms or feel sick or anxious if you suddenly stopped taking your drug of choice?

6.  Do you feel that the way you use drugs leads to more negative than positive experiences?

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