More on the DSM-V

The Fix has a good opinion piece on the DSM-V, praising its movement away from dependence and abuse.

The focus on dependence also implied that cocaine—which does not produce physical dependence—isn’t “really” addictive. That lulled many people in the ’80s—including yours truly—to think that cocaine wasn’t likely to be hard to kick. We all know better now.

Moreover, with the term “dependence” in the medical definition of addiction itself, it became very difficult to teach people that needing a drug to function isn’t the essence of addiction. The misdefinition encapsulated the idea that suffering withdrawal—rather than compulsive use despite negative consequences—was fundamental to the problem. That meant that the drive to take drugs—now demoted to being called merely “psychological dependence”—was less important than getting sick if you couldn’t get the drug.

In reality, this desire—and related repetitive drug-taking—matters far more than how sick you get when you try to stop.

I’m in complete agreement. All of our public education on addiction has to go through explaining that only 2 dependence diagnostic criteria out of 7 focus on physical dependence (3 criteria are required for a diagnosis.) and that dependence and addiction are not the same thing.

That said, I’m pretty concerned about the spectrum approach planned for the DSM-V. While problem AOD use and addiction may behaviorally appear to be part of the same continuum, they are categorically distinct rather than being different degrees of the same problem.

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