Many of us picture addicts as druggies in dark alleyways, and that kind of stereotyping is exactly why the American Psychiatric Association’s (APA) released its latest revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) this year. The DSM-V is the universal manual for diagnosing mental and behavioral health issues, and this newest revision eliminates the addiction categories and replaces it with a new category for substance use related disorders.
Substance use refers to non-medical uses, but what about substances that are not illegal, but not always medicinal? One college professor can't teach without his morning coffee, and some of his students can't make it through their homework without an energy drink. Caffeine, classified as a schedule 3 stimulant drug, is used in some medications, but is also the drug abused by more people than any other drug. For these reasons, the APA moved caffeine to Section III of the manual for further research and study as a “Caffeine Use Disorder”, relating to the potential addictive behavior caused by excessive, sustained consumption of caffeine. MyAddiction.com has more information about treatment for caffeine addiction.
Not all substance use is about legality. Marijuana has been approved for some uses in some states, and there was not enough evidence previously to include withdrawal under the cannabis category. However, research in the last fifteen years has provided enough for this to be added to the manual. The DSM-V includes new criteria for “cannabis withdrawal”, which the APA says is caused by “cessation of cannabis use that has been heavy and prolonged,” results in “clinically significant distress or impairment in social, occupational, or other important areas of functioning.” Addiction-Treatment.com has treatment resources for marijuana abuse.
What about addicts that don't use a substance? A woman often cannot pay her bills because she goes to the casino after work every day, and a man is confused that his wife wants a divorce because of the time he spends video gaming. A new category of behavioral addictions address these kinds of issues. Gambling has been added to this category, due to its similarity in “clinical expression, brain origin, comorbidity, physiology, and treatment” (DSM-5.org Fact Sheet). The DSM-V fact sheet points out that “internet gaming disorder” has also been added, and that both internet and social media addictions still being studied and researched. This category may also include food addictions and sexual addictions in the future. Some treatment resources for behavioral addictions include Gamblers Anonymous, The Center for Internet Addiction, Best Video Game Treatment Centers, Food Addicts Anonymous, National Eating Disorder Association, and Addiction Recovery.
The DSM-V includes 11 symptoms to assess for substance use. Cravings, or urges to use the substance, is a new one added in this addition. One woman "shopped" for doctors to keep prescriptions of medication she no longer needed, and another woman continued using illegal drugs despite losing custody of her children. One man overdosed by using more than he meant to, while another man lost his job because he got so behind on his work while using.
Addictions are not called addictions anymore, and now referred to as substance use disorders. The goal for this change is to focus on drug-seeking behavior and the impact of substance use rather than only withdrawal symptoms. The National Institute on Drug Abuse has an excellent resource guide for explaining what kinds of help are available, and the Substance Abuse and Mental Health Services Administration has contact information for help sorting through treatment options, or you can call 1-800-662-HELP (4357).
Emily Christensen lives with her husband in Oklahoma. Her Ph.D. is in marriage and family therapy and she is pursuing a second degree in Hebrew and Jewish studies. Her blog is housewifeclass.com.