Never Fear, the New D.S.M. Won’t “Create More Addicts”

Wednesday, May 16th, 2012

DSM ManualLast week’s New York Times article, “Addiction Diagnoses May Rise Under Guideline Changes,” offers a sadly pejorative take on the proposed changes to the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M.—the go-to manual for mental health (including substance use disorder) diagnoses. The reporter writes that the rewritten D.S.M. “could result in millions more people being diagnosed as addicts.”

There are a couple of problems with this speculation. First, people are not diagnosed “as addicts.” This is because there is no diagnosis of “addiction”—not in the current DSM or the revised version. To characterize the diagnosis of substance use disorders this way simply shows the extent to which stigma and depreciatory attitudes about this illness remain.

Second, the new D.S.M. would do one important and enormously beneficial thing: it would allow problematic and/or harmful drug use to be identified and diagnosed earlier. This is the first time Medicaid/Medicare have reimbursed effective services for people who misuse substances—not just for folks who qualify as chemically dependent. This is where programs like Phoenix House’s SBIRT (Screening, Brief Intervention, Referral to Treatment) come in. These programs, along with the new D.S.M., will help us catch and treat substance use problems before they become life-threatening—and before they require the expensive treatments that the Times article references. The fact that SBIRT is now available and funded is no small feat; to quote Dr. Keith Humphreys, former drug control policy adviser to the White House, this is in fact “the single biggest expansion in the quality and quantity of addiction treatment this country has seen in 40 years.”

Third, the article paints a ridiculous picture of the guys who wrote the new D.S.M. They aren’t money-grubbing evil scientists who take money from pharmaceutical companies to support an elaborate research ruse. I know many of these researchers—they’re passionate about the cause, and the D.S.M. is their labor of love. They put in a great deal of work with their efforts to better characterize the DSM categories, which will allow more people to get help. Why would The New York Times be so one-sided in criticizing these efforts? In reality, these researchers are the ones who want to help people the most.

So never fear, the new D.S.M. will not cause more people to be diagnosed with addiction. Instead, more people who may not yet be addicted (but whose drug use is nonetheless problematic and unhealthy) will be able to access very inexpensive but proven effective treatment earlier and easier. Treating these folks is no different from treating those in the early stages of diabetes—it requires minimal professional help, some education, and simple lifestyle changes. We wouldn’t wait until a pre-diabetic started experiencing the symptoms of full-blown diabetes before we offered him or her help. Instead, we would intervene early in hopes of preventing such a difficult future. The same should apply for those with early substance misuse.

Deni Carise, Ph.D.
Chief Clinical Officer
Phoenix House

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  • The idea of creating more diagnostic disorders to enhance treatment, has fatal flaws. 85% of people with SUD NOW don’t have access to treatment and these are the ones who, besides being at risk for dying, are costing $$$$ in costs for corrections, medical and other social services.

    This compassionate urgency to get more people help, could also have the effect of disqualifying many people from a number of career paths, by attaching a mental health label that will not go away.

    There is a very rational reason why “early intervention” is not considered treatment of a diagagnosed mental disorder.

    One can see why this revision may be suspect… whose interests are really going to be served?

  • Thanks for your comment, Nikki. It’s actually not true that 85% of people don’t have access to treatment; rather, according to the NHSDUH, 85% of people who “meet criteria for substance abuse or dependence don’t get treatment.” Sometimes this is because they don’t have the funding or transportation, but many don’t seek treatment simply because they don’t want it. Plus, with healthcare reform more people will have insurance so that folks who DO want treatment will be able to access it. As for disqualifying people from career paths, I’m doubtful. People in recovery are doctors, lawyers, actors, teachers, pilots…the list goes on. Folks can and do overcome addiction and go on to fulfill their dreams—and I’m living proof!