What's So Bad About the New Definition of Addiction?

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Among the millions of people who will be diagnosed with an addictive disorder in the new DSM are many whose lives will be derailed by their substance use, leading to car accidents, suicide, brain damage, sexual trauma and a host of less severe outcomes. The new criteria will allow clinicians to intervene at an earlier stage in the addiction cycle, when relatively brief and inexpensive treatments can prevent more serious problems from escalating. Psycho-education, psychotherapy and group support should be available for people who seek treatment early on. Who would argue that it’s better to wait until the substance use escalates before treatment can be initiated?

As for the inclusion of cravings and urges as diagnostically legitimate, this is an important step forward because it recognizes the unique patterns and complexities of addiction’s actual clinical picture. One person might suddenly find himself pounding down shots at a bar or relapsing with cocaine without ever having consciously grappled with a desire to use. Someone else will carefully inventory and explore his urges, triggers and “close calls” prior to  relapse. Again, I believe that somebody in this situation is an excellent candidate for treatment geared toward relapse prevention.

Excessive gambling, sex, internet use and other activities can cause distortions of experience that mirror substance use disorder.

I think that including gambling in the broad category of addictive disorders is clinically valid. All addictions involve a pathological development toward behavior that is increasingly compulsive and restricted. Classifying Gambling Disorder as an addiction is a step toward acknowledging that a range of behaviors can become out of control. Obviously, alcohol and drugs act directly on the brain, creating an unmediated effect on pathways and regions that are implicated in addiction. This may make them especially resistant to amelioration. But excessive or maladaptive patterns of gambling, sex, internet use, eating and other activities can cause diminishment and distortions of experience in a way that mirrors substance use disorder. A substance is not a prerequisite for an addictive disorder.

In the end, all addictions can be devastating. Changing the diagnostic indicators will not drag people unwittingly into treatment or dictate the approach that a given provider will use. The most significant likely consequences of the revision of the diagnostic criteria are expanded and earlier intervention and treatment. In the long run, these are benefits that will prove not only lifesaving but cost-effective. Who can argue with that?

Please let us know what you think of the DSM-V revisions to the addiction diagnosis by posting a comment below.

Richard Juman is a licensed clinical psychologist who has worked in the field of addiction for over 25 years, providing direct clinical care, supervision, program development and administration across multiple settings. A specialist in geriatric care and organizational change, he is also the president of the New York State Psychological Association. His email is dr.richard.juman@gmail.com; he tweets are twitter:@richardjuman