It’s no secret that many people with substance use issues are confused as to how to label their problematic behavior: is it abuse or dependence? And, what’s the difference anyway? Mental healthcare professionals struggle with these terms themselves—and when it comes to getting insurance to pay for any type of treatment for substance use disorders, definitions mean everything.
In light of a “wealth of new research and knowledge about mental disorders,” in 2013 the American Psychiatric Association (APA) decided to make some pretty big changes to the Diagnostic and Statistical Manual of Mental Disorders, the association’s de facto diagnostic bible. Most importantly, when describing addictive behaviors, “substance abuse” and “substance dependence” were thrown out in favor of the larger umbrella term “substance use disorder.” Another significant change is that tobacco use has now been upped to an actual disorder, and two drugs, cannabis and caffeine, now have defined withdrawal symptoms.
In 2013, the APA released an updated version of its Diagnostic and Statistical Manual of Mental Disorders, or DSM. The fifth edition, known as the DSM-5, defines substance use as a disorder on a spectrum. According to the DSM-5, a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria. For alcohol use disorder, for example, some of the diagnostic criteria include problems controlling the amount of alcohol a person drinks, continued drinking in spite of problems resulting from drinking, acquiring a tolerance to larger amounts of alcohol, drinking that lends to risky situations, or developing withdrawal symptoms.
The criteria for a DSM-5 substance use disorder diagnosis are nearly the same as the combined criteria for a diagnosis of substance abuse or substance dependence in previous versions of the DSM, with two exceptions:
Part of the problem with the old terminology is that substance abuse and substance dependence were difficult to distinguish. Someone can abuse a substance but be neither dependent nor addicted to it. Dependence and addiction can also occur independent of one another. For instance, someone can be dependent on prescription medication but not addicted. “Addiction conveys both social and health problems, whereas dependence only encompasses the latter,” according to the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment.
To qualify for a substance use disorder, a person must meet at least two criteria now, whereas before, only one was needed for a diagnosis of substance abuse while three were required for substance dependence. The new DSM-5 classifies substance use disorders as mild, moderate, and severe subtypes. Severity of a substance use disorder is based on the number of criteria met: 2–3 criteria indicate a mild disorder; 4–5 criteria, a moderate disorder; and 6 or more, a severe disorder.
Some reports indicate the changes were made in an effort to both increase the reliability of a diagnosis by requiring more symptoms be met, as well as help to more specifically define “dependence”—which, as mentioned, does not necessarily imply abuse or addiction. “In this sense, the new DSM-5 criteria recognize that mental and behavioral aspects of substance use disorders are more specific to substance use disorders than the physical domains of tolerance and withdrawal, which are not unique to addiction,” as explained by Bret S. Stetka, MD and Christoph U. Correll, MD in an article on Medscape.
The newest version of the DSM also lists a handful of new disorders, one of which is tobacco use disorder. The criteria for DSM-5 tobacco use disorder are the same as those for other substance use disorders.
Gambling disorder is also now listed as a substance use disorder. Gambling, like other behaviors that stimulate the brain’s reward circuitry to reinforce actions that become addictive, is generally referred to as a “behavioral addiction.” While cannabis use disorder and caffeine use disorder are not yet recognized as substance use disorders, the DSM-5 does list categories for cannabis withdrawal and caffeine withdrawal.
Drug treatment centers, such as Cornerstone Recovery Center, can successfully diagnose substance use disorders and help you get started on the path to recovery. If you think you or a loved one is suffering from substance abuse or dependence, our experienced admission counselors are on hand to help place you in a recovery program that is right for you. Call us directly at 888-711-0354 or contact us online today.