New Definitions Offer Improvements, Miss the Mark in Major Areas of Opportunity
Key Facts:
- Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, which was released in May 2013, broadens the definition of addiction.
- The broadened definition encourages earlier treatment, but ignores reasons that patients abuse substances in its definitions and treatment plans.
- Addictions never occur on their own, but are always a person’s poor attempt to self-medicate a deeper psychological hurt.
- To get at the underlying hurt and bring lasting healing to it, I recommend a holistic – spirit, mind, body – approach to addiction diagnosis, management and treatment.
Great controversy exists around the new, expanded definition of addiction listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. There are some clear benefits to the refined definition:
- There is less confusion about whether to categorize the patient as substance abuse or substance dependence, as these are combined and put on a spectrum under the DSM-5 definition.
- Patients who are taking prescription pain medications according to their doctor’s orders will not be considered addicts, even though they might have a physiological dependency on the drug.
- New categories of behavioral addiction will now be recognized which includes pathological gambling. Soon to be included are shopping, Internet, sex, pornography, screen, and work addictions.
Under the new definition, the list of possible symptoms used to diagnose someone with addiction increases, while the number of symptoms an individual must exhibit to be diagnosed with a substance use disorder decreases. As a result, more people will receive substance use diagnoses, but sadly, in many cases, underlying causes of substance abuse will never be addressed.
I expect that the broader nature of the DSM’s new addiction definition will hopefully help individuals with a wide variety of addiction issues receive quicker diagnoses and treatment, but with this redefining, we are missing a major opportunity to identify core issues that lead to continued addiction activity.
We have an opportunity to outline and categorize the spectrum of addiction based on why substance users choose to use from their very first substance encounter. Identifying these reasons after a user experiences several consequences is often too late. I equate it to receiving a getting a stage 4 or 5 cancer diagnosis when you could have caught it at stage 1 or 2.
I know from my own alcohol addiction that both psychological and spiritual issues must be addressed for true recovery to take effect. These are key components to the treatment programs I am blessed to help design.
As a practice, we focus too narrowly on what we can fix from a medical perspective. Research shows us that spirituality can influence addiction recovery from a wide variety of vantage points. It’s time to infuse that treatment knowledge into the diagnostic criteria, so we can finally bring spiritual power and clearer psychological understanding to individuals and society about how to diagnose and cure addictions.
For the last 20 years we have talked a good game about a holistic approach to well-being but we have made little progress because we are afraid of spirituality, God, and divine power.
Decision-Making sciences will eventually be the key that cracks the secret code that is Addictions, because decision-making is where all three spheres of Spirit, Mind, and Body intersect in a powerful and magical way. We say Addictions are holistic illnesses that need a holistic treatment approach, but since much of the medical and behavioral health profession is afraid to use God in the diagnostic testing or prescription pad, we shouldn’t be surprised at our difficulty in fully curing addictions using the current hyper-medicalized model.