DSM-5 Alcohol Use Disorder Diagnosis Draws Controversy

Substance Abuse

DSM-5 Alcohol Use Disorder Diagnosis Draws Controversy

There is a lot of stigma and much controversy that surrounds substance abuse. Many people have different opinions and perspectives concerning how to treat those who suffer the most. However, they can all agree on one thing: it’s a problem and it needs to be solved.


“Substance” is defined as an intoxicating, stimulating, or narcotic chemical or drug, especially an illegal one.

“Dependence” in this case does not mean addiction. The term dependence can refer to how the body normally responds to a substance. The more a person takes a substance, the more dependent the body becomes.

Abuse vs Addiction 

There is often a lot of confusion about whether substance abuse is addiction. Let’s define the two terms:

Addiction is diagnosed clinically as a “condition involving compulsive use of a substance despite negative consequences.”

Abuse is the “inappropriate use of substances for pleasure, to perform better, or to change one’s perception of reality.”

Often, the difference also has to do with timing. Developing a tolerance and developing cravings which both lead to addiction takes time. Abuse of a substance can happen almost immediately.

There is also one other key difference between abuse and addiction: the ability to stop using. It’s extremely hard for those who are addicted to substances to stop using. Someone who is abusing is ly to have an easier time cutting themselves off the substance.

However, ongoing use or abuse of substances often leads to addiction. The regular use of the substance can build up a tolerance. This tolerance does a few things: First, it makes the user want more. They crave the substance.

Second, if they started using the substance for a specific purpose (anxiety management, pain management, social situations, etc.), they may depend on the substance for stressful situations. They may believe they need it to function, thus creating a psychological dependence and an addiction.

DSM-5 definitions

The DSM-5, or the Diagnostic and Statistical Manual of Mental Disorders, has the different criteria that need to be met to be diagnosed with a substance abuse disorder or an addiction. Each disorder has been defined and the diagnosis criteria is laid out beneath. Please find them below.

If your loved one is showing signs of any of the following, please reach out for help.

Drug Abuse

A drug abuse problem is signified if one or more of these issues has been met in the past year:

  1. Legal problems caused by drug abuse or behaviors under the influence
  2. Physical harm to others caused by the individual’s use of drugs and/or his behaviors under the influence (or lack of action caused by the use of drugs)
  3. Inability to do what is necessary at home, at school, at work, or to manage responsibilities in general
  4. Ongoing use of drugs despite continued problems in these and other areas caused by drug abuse

Drug Addiction

A drug addiction problem can be diagnosed if three or more of the following issues occur within a 12-month period:

  1. Onset of withdrawal symptoms when without the drug of choice
  2. Using larger and larger amounts of the drug of choice in order to achieve the same results experienced initially
  3. Less interest in old hobbies and interests in career/school pursuits
  4. Withdrawing from friends and family
  5. Patterns of behavior that revolve solely around getting or staying high
  6. Multiple attempts to cut down or stop drug use without success
  7. Continued use of drugs and alcohol despite continued and growing problems related to their use

Alcohol Use Disorder

Below is the DSM-5 criteria for alcohol use disorder (AUD).

There are 11 criteria under AUD in the DSM-5. The severity of the disorder is the number of criteria the patient meets. The severity levels are: mild, moderate, and severe. If the score is 0-1, the patient doesn’t have AUD. 2-3 is mild; 4-5, moderate; and 6+ is severe.

  1. Missing work or school
  2. Drinking in hazardous situations
  3. Drinking despite social or personal problems
  4. Craving for alcohol
  5. Build up of tolerance
  6. Withdrawals when trying to quit
  7. Drinking more than intended
  8. Trying to quit without success
  9. Increased alcohol-seeking behavior
  10. Interference with important activities
  11. Continued use despite health problems


There is huge controversy surrounding substance abuse and addiction. Here in the U.S., we tend to look down at people who are in trouble with substances. We tend to assume that they have failed in some way.

This is one of the big controversies: only “bad people” or those who have “failed at life” are addicted or abuse substances. Addiction or substance abuse is a world only for the low-income or homeless, or those with criminal records.

On the contrary, however. Addiction and substance abuse has the ability to affect everyone throughout every race, culture, belief system, and through every economic status.

Another big controversy surrounding substance abuse and addiction is the argument of whether it’s a disease or a choice.

People who believe substance abuse is a disease might cite groups the AMA, APA, and WHO, which all have proof and facts stating that addiction is indeed a disease – using the substance has effected the brain long-term. Those who believe substance abuse is a choice might argue that no one forced the person to start using and therefore it can and should be stopped.

There are many other controversies surrounding the issue of substance abuse and addiction. They include: “Do people who abuse drugs or are addicted deserve treatment?” “Does an addict need to hit “rock bottom” to get help?” “Are sober living homes good or bad?”

These are difficult questions, and the answers are just as complicated. Not only do the consequences of the actions taken to “fix the problem” affect families, but they affect neighbors, cultures, businesses and the economy, the medical and mental health industries, the justice and prison systems, and more.

It is not an easy fix.

Is Treatment Needed?

There are a number of serious signs related to substance abuse. If you witness any of these symptoms, substance abuse may be an issue that needs to be addressed in treatment as soon as possible.

  • Isolating from family and friends who don’t do drugs
  • Spending time with new friends or friends who get high or drunk
  • Never having money or often asking to borrow money, even for small items
  • Showing up late to work/school or not showing up at all
  • Losing a job
  • Doing little to find a job if work
  • Paying less attention to basic hygiene
  • Changes in sleeping habits
  • Extremely private about possessions, including their bags, room, or car
  • Lying about using or drinking
  • Sneaking away to get high or drunk

If you or your loved one are showing any of these signs, or know anyone who is, please reach out for help.

Realities of Substance Abuse

The earlier one starts abusing substances, the more ly one will become addicted. Substance use and abuse can start a pattern of unsafe behaviors in teens and young adults which can affect their lives in serious and dangerous ways:

  • Addiction
  • Poor judgement
  • Impaired memory
  • Injury due to intoxication
  • Lifelong legal problems
  • Development of mental health issues
  • Serious and irreversible health problems such as HIV, Hepatitis C, damage to major organs
  • Overdose
  • Prison
  • Death

Treatment Options

“Rock bottom” isn’t the point where you want to start treatment for your loved one. If possible, start getting help as soon as the signs and symptoms are noticed.

Hitting “rock bottom” can certainly wake people up to the reality of the path they’ve chosen, but the chances of your loved one getting help and recovering are much better if the signs are noticed sooner.

Below are some treatment options available for you and your loved one. Please read them carefully and do extensive research to find the treatment option that is best for your loved one.


Interventions are good ways to get your loved one to understand how the choices and actions they make are affecting everyone around them.

Family, friends, and coworkers will gather together with their loved one to discuss the issue. Everyone will sit down and be open and upfront about how they have been treated. Interventions can be an intense and emotional time for everyone.

However, it’s extremely important for the suffering individual to understand that their actions have negatively impacted the people in their life.

Being forced to face the reality will be a startling wake-up call, but it might be exactly what your loved one needs.

During the intervention, everyone will talk about how the issue has negatively impacted their lives. Your loved one will then have the opportunity to apologize for their choices and actions. Take your time and remember that this is an emotionally charged time for everyone – especially for your loved one.

After the intervention, your loved one will have the choice of going to treatment or not. Make sure to come up with a plan if they say “no” to treatment.

Consider having a professional interventionist present as well. They are trained in conducting calm and successful interventions.

Recovery Programs

There are many recovery programs available to those who are suffering from substance abuse issues.

These recovery programs all follow a basic structure:

  • Detox
  • Treatment & rehabilitation
  • Therapy
  • Classes
  • Outpatient

Every program has unique treatments. Please research the recovery programs extensively. There are programs available for whatever you and your loved one need.

Hotlines & Chat Rooms

Hotlines and chat rooms are good treatment resources if you or your loved one are in need of help or support.

If you’re a family member or friend who has a loved one dealing with substance abuse or addiction, hotlines and chat rooms can give you the support and help you need.

Final Thoughts

Everyone is affected by substance abuse. It is not confined to a single culture, race, city boundary, or economical status.

There are many signs for drug abuse, drug addiction, and AUD. Please read the information for each diagnosis carefully. Your loved one can be helped if the signs are identified quickly.

If you or your loved one is struggling with substance abuse or addiction, please call 1-888-975-SAVE (7283) or visit Universal Crisis Intervention: Home for more information.


Substance Abuse | Healthy People 2020

Substance Abuse and Addiction

Difference Between Abuse and Addiction

Early Intervention, Treatment, and management of Substance Use Disorders

Is there a difference between physical dependence and addiction?

DSM-5 Substance Abuse Disorders Draws Controversy

5 Controversial Thoughts We Have About Addiction

Illegal Drugs

Reports, Fact Sheets, and Publications | YRBSS | Data | Adolescent and School Health

Источник: https://universalcrisisintervention.com/interventions/substance-abuse/

DSM-5 Alcohol Use Disorder Diagnosis Draws Controversy

DSM-5 Alcohol Use Disorder Diagnosis Draws Controversy

Eskuzko diagnostikoa alkoholaren gehiegikeria eta alkoholaren menpekotasuna konbinatzen ditu

Berrikusketen hamarkada bat baino gehiago igaro ondoren, American Psychiatric Association (APA) Diagnostic and Statistical Manual of Disorders Mentalen (DSM-5) bosgarren edizioa argitaratu zen 2013an, baina ez polemikarik gabe. DSM-5 oso osasun-profesionalek erabiltzen dute portaera-osasunerako arazoak diagnostikatzeko eta aseguru-fakturazioetarako erabiltzen da.

DSM-5 berriaren hainbat atalek kritika egin dute, alkoholismoari buruzko atala barne.

Alkoholaren gehiegikeria nahasteak

1994an argitaratutako DSM-IV eskuliburuaren aurreko bertsioan, alkoholaren erabilera nahasteak bi kategoriatan banatu ziren: alkoholaren gehiegikeria eta alkoholaren menpekotasuna .

APAren arabera, «gehiegikeria eta mendekotasunaren arteko bereizketa gehiegikerien kontzeptua abiapuntutzat edo hasierako fasean oinarritzen zen, eta menpekotasuna manifestazio larriagoa izan zen».

Bi diagnostiko bereizi beharrean, eskuliburu berrikusiak alkoholaren erabilera nahasteak (AUD) diagnostikatu ditu, eta APAren arabera, «pazienteen esperientzia duten sintomekin bat datoz».

Eskuliburuan bosgarren edizioan, AUD motak moderatu edo larriak izan daitezke. Diagnostikoa 11 irizpideren arabera dago. Desordena larritasuna pertsonek betetzen duten irizpideen arabera sailkatzen da. 0tik 1era, pertsona ez du AUD.

2tik 3ra, diagnostikoa epelak dira; 4tik 5era, moderatua; eta 6 edo gehiago, larria.

Konfusioa epe mailan

APAren arabera, bi diagnostiko bereizi konbinatzeko arrazoia bat izan zen nagusiki, alkoholaren mendekotasunaren diagnostikoa nahasmena eragin zuen. Jende gehienak mendekotasuna pentsatu zuen mendekotasuna ekarri zuen.

Mendekotasuna, ordea, gorputzari erantzun egokia ematea ahalbidetzen du substantzia bat erabiliz, esate baterako, fisiologikoki medikazio baten mende dagoenean medikuaren preskripzio erregimena jarraituz gero.

11 Alkoholaren gehiegizko nahasteen diagnostikoari buruzko irizpideak

Azalpen laburtuak honako hauek dira: osasun profesionalek diagnostikatzeko erabiltzen dute alkoholaren erabilera nahasmeneko 11 irizpide gisa:

Diagnostikorako irizpideak Alkohola erabiltzeko nahasteak (AUD)
Lan edo eskola falta
Egoera arriskutsuak edaten
Arazo sozialak edo pertsonalak izan arren
Alkoholaren nahia
Tolerantzia eraiki
Irten saiatzean irtetean
Xedea baino gehiago edaten
Irten saiatzen arrakastarik gabe
Handitu alkoholaren bila jokatzea
Jarduera garrantzitsuei buruzko interferentziak
Etengabeko erabilera osasun arazoak izan arren

Etengabeko irizpideak aldatu egin ziren arazo legalak berreskuratzeko aurreko sintoma ordezkatu zuen APAk, kulturaren gogoetak desberdinak izan zirelako, nazioartean aplikatzeko irizpideak zailak izan zirelako.

Kritikarien erreklamazioa alkoholismoaren berrikustea, irizpide berriekin

Irizpide berrien arabera, asteburuetan edaten duen unibertsitateko ikasle bat eta, noizean behin, klase bat falta den alkohol gehiegizko trastornoa diagnostikatuko lukete. Hau polizia eztabaida da.

Kritikarien ustez, irizpide berrikusketak unibertsitateko edo adin txikikoen betaurrekoak alkoholiko epelak bezain gaiztoak izan litezke, diagnostikoa haien ondorengo urteetan jarraitu ahal izateko.

Task Force-k eskuliburu berriena sinesten du diagnostiko zehatzagoetarako

Eskuliburua berrikusten lagundu duen zeregina indargabetzen da irizpide berriak norabide egokian pauso bat da, nahastearen diagnostiko zehatzagoa lortzeko.

«Substantzia gehiegikeriaren eta mendekotasunaren alorrean azken bi hamarkadetan ikerketa garrantzitsu bat lehertu da», esan du David Kupfer doktoreak, DSM-5 lantaldearen indarraren lehendakaria. «Aldaketak eremuan zientzia onena islatzen dute eta nahaste horiek diagnostikatzeko argitasun berri bat eskaintzen dute».

Aurreko DSM-IV-ren egileetako batek ez du ikerketarik diagnostikoan faktore bakarra izan behar. «DSM-5 goiz hartan alkoholikoekin hasitako drinkers-ean hartutako erabakia etengabeko gazteek bizi duten moduan sentikorra ez den ikertzaileek bultzatu zuten», esan du Allen Frances doktoreak, DSM-IV lantaldearen indarraren burua.

Ikasketa batek beste irizpide batzuk erakusten ditu diagnostikoa ez da asko egiten

Ikertzaile zientifiko batek 2013an 7.000 bikilek ikasi zuten Virginia Commonwealth Unibertsitatean ikertzaileek erakusten dute irizpide berriak ez direla alkoholarekin erlazionatutako diagnostikoa hobetu. Irizpide berriak ez dira diagnostiko gutxiago zehazten.

Diagnostikoak areagotzea

Berrikusketen kritikek DSM-5-k gaixotasun mentala deritzonaren zerrenda zabaldu eta diagnostiko handiagoak sorrarazten ditu.

DSM-5 kritikarik kaltegarrienak Osasun Mentaleko Institutu Nazionalak (NIHM) izan ziren, eta eskuliburuaren laguntza bi aste lehenago argitaratu aurretik argitaratu zen.

NIMH, osasun mentaleko ikerketarako finantziazio-agentzia handiena, iragarri zuen DSM kategoriatik urruneko ikerketa berriro bideratzea.

Bilera-irizpideak ez da nahikoa diagnostikoa egiteko

Thomas Insel doktoreak dioenez, NIMHren zuzendaria eskuliburua kaleratu zenean, DSM-5ren arazo nagusia baliozkoa zela esan zuen. Bilera-irizpideak ez da nahikoa izango diagnostikoa bermatzeko.

Esan zuen: «Hau bularretako mina edo sukarraren kalitatea oinarritzat hartuta diagnostiko-sistemak sortzea izango litzateke baliokidea litzateke», sintomak oso gutxitan tratamenduaren aukerarik onena edo diagnostiko zehatza adierazten dutela.

NIMHk bere Ikerketa Domeinuen Irizpideak (RDoC) garatzen ari da DSMren alternatiba gisa. Buruko nahasteak sailkatzeko modu berriak aurkituko lirateke portaera behagarriaren dimentsioetan eta neurri neurobiologiko objektiboetan.


American Psikiatriko Elkartea. «Substantzia erlazionatutako eta Addictive nahasteak.» 2013ko maiatza.

Edwards, AC, et al. «Alkoholaren erabileraren trastornoaren diagnostikoa DSM-5 modulua ebaluatzea Genetika Informaziorako Biztanleriaren batean». Alkoholismoa: ikerketa klinikoa eta esperimentala . 2013ko urtarrilaren 24a.

Insel, T. «Diagnostikoa eraldatzea». Osasun Mentaleko Institutu Nazionala. 2013ko apirilaren 29a.

Elkartasuna eta DrugFree.org. «Osasun Mentaleko Desoreka Eskuliburuaren kritikak esan gaixotasun mentala gehiegizkoa dela». Batu zaitez. 2013ko martxoaren 29a.

Источник: https://eu.reoveme.com/dsm-5-alcohol-use-disorder-diagnosis-draws-controversy/

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