In the United States, psychiatrists use the Diagnostic and Statistical Manual of Mental Disorders or the D.S.M. as the guidebook for diagnosing psychiatric disorders. Lawyers and judges use the manual to determine whether or not defendants are mentally competent to stand trial, and health insurance companies and the government use it to determine what type of coverage to offer customers and citizens. The manual has not been revised in 16 years.

Proposed Revisions

This year, however, the American Psychiatric Association has decided to change the definition of addiction. The revisions will take up to two years, as psychiatrists and other specialists will have the opportunity to comment on the proposed changes. The revisions will address Asperger's syndrome and autism spectrum disorders, identifying early stages of dementia and psychosis, binge eating, and addiction.

Controversy

The revised definition of addiction is causing the most controversy. That definition for addiction, reports the New York Times, will be expanded both in scope of things that people can be addicted to and the symptoms addicts show. In the current manual, addiction is designated as “substance abuse" and “substance dependence." If the proposed changes hold, addiction will simply be labeled “substance use disorder."

The authors are considering adding gambling to the list of recognized addictions as well as “behavioral addiction – not otherwise specified." Video game, Internet, shopping, and sex addictions may all be classified under the unspecified “behavioral addiction."

In addition to the new addictions, the manual would include more symptoms of addiction and require patients to exhibit fewer of the symptoms before being diagnosed with “substance use disorder."

Possible Effects Of The Proposed Revisions

Some psychiatrists are pleased with the proposed changes, arguing that people with addictions will now be properly diagnosed and treated.

Critics, however, point to a host of problems:

  • More people will be diagnosed as addicts.
  • The new definitions will create a “false epidemic" that identifies users of substances and activities as addicts while ignoring those who suffer stronger addictions.
  • Public funding in schools, prisons, community health centers, Medicare and Medicaid will be stretched to new patients who do not show all of the traditional addiction symptoms.
  • Research has not yet determined whether things such as sex addiction, Internet addiction, or gambling addiction exist.
  • Private health care costs will increase as more people seek insurance claims for treatment.

Supporters of the proposed changes counter the critics' arguments.

  • More addicts will receive treatment because their addictions will be verified by the manual.
  • Addiction will be identified as a spectrum disease.
  • Addicts can receive treatment earlier when consultations and counseling would be more effective than prescription medication.
  • Health care costs will be lower if addicts receive treatment earlier, decreasing the number of necessary organ transplants and lengthy rehabilitation center stays.

Whether the proposed changes are maintained or revised, the ability for doctors and psychiatrists to consider addiction in a different light—derived from various causes—is crucial for the practice of psychiatry.

Controversy Over Revising Addiction