WASHINGTON — In what could prove to be one of their most far-reaching decisions, psychiatrists and other specialists who are rewriting the manual that serves as the nation’s arbiter of mental illness have agreed to revise the definition of addiction, which could result in millions more people being diagnosed as addicts and pose huge consequences for health insurers and taxpayers.

The revision to the manual, known as the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., would expand the list of recognized symptoms for drug and alcohol addiction, while also reducing the number of symptoms required for a diagnosis, according to proposed changes posted on the Web site of the American Psychiatric Association, which produces the book.

In addition, the manual for the first time would include gambling as an addiction, and it might introduce a catchall category — “behavioral addiction — not otherwise specified” — that some public health experts warn would be too readily used by doctors, despite a dearth of research, to diagnose addictions to shopping, sex, using the Internet or playing video games.

Part medical guidebook, part legal reference, the manual has long been embraced by government and industry. It dictates whether insurers, including Medicare and Medicaid, will pay for treatment, and whether schools will expand financing for certain special-education services. Courts use it to assess whether a criminal defendant is mentally impaired, and pharmaceutical companies rely on it to guide their research.

The broader language involving addiction, which was debated this week at the association’s annual conference, is intended to promote more accurate diagnoses, earlier intervention and better outcomes, the association said. “The biggest problem in all of psychiatry is untreated illness, and that has huge social costs,” said Dr. James H. Scully Jr., chief executive of the group.

But the addiction revisions in the manual, scheduled for release in May 2013, have already provoked controversy similar to concerns previously raised about proposals on autism, depression and other conditions. Critics worry that changes to the definitions of these conditions would also sharply alter the number of people with diagnoses.

While the association says that the addiction definition changes would lead to health care savings in the long run, some economists say that 20 million substance abusers could be newly categorized as addicts, costing hundreds of millions of dollars in additional expenses.

“The chances of getting a diagnosis are going to be much greater, and this will artificially inflate the statistics considerably,” said Thomas F. Babor, a psychiatric epidemiologist at the University of Connecticut who is an editor of the international journal Addiction. Many of those who get addiction diagnoses under the new guidelines would have only a mild problem, he said, and scarce resources for drug treatment in schools, prisons and health care settings would be misdirected.

“These sorts of diagnoses could be a real embarrassment,” Dr. Babor added.

 

Read more at New York Times

Are you or have you ever been a college binge drinker? Welcome to alcoholism, a diagnosis your college self could qualify for under the changes proposed to the next edition of psychiatry’s diagnostic manual, the DSM 5.

As the New York Times noted on Saturday in an article that rapidly became one of the most emailed, DSM 5 will have just one diagnosis for addiction problems, though it will be characterized as either mild, moderate or severe. Currently, alcohol and other drug problems come in two flavors.  The first, “substance abuse” is a short-term, self-limiting problem: it encompasses most heavy drinking in college.  The second “substance dependence,” is what everyone else calls addiction or alcoholism and is typically chronic and marked by relapses.

Fortunately, the new diagnosis will get rid of the confusing term “dependence” (physically needing a drug to function isn’t actually addiction) and the stigmatizing term “abuse.” Unfortunately, however, it will also tremendously elevate the number of people considered alcoholics.  One Australian study suggested that using DSM 5 definitions will increase the number of people diagnosed with alcoholism by a stunning 60%.

Ian Urbina writes:

“The chances of getting a diagnosis are going to be much greater, and this will artificially inflate the statistics considerably,” said Thomas F. Babor, a psychiatric epidemiologist at the University of Connecticut who is an editor of the international journal Addiction. Many of those who get addiction diagnoses under the new guidelines would have only a mild problem, he said, and scarce resources for drug treatment in schools, prisons and health care settings would be misdirected.

“These sorts of diagnoses could be a real embarrassment,” Dr. Babor added.

Proponents of the new system argue that it will allow substance problems that might develop into serious addictions to be nipped in the bud:

“We can treat them earlier,” said Dr. Charles P. O’Brien, a professor of psychiatry at the University of Pennsylvania and the head of the group of researchers devising the manual’s new addiction standards. “And we can stop them from getting to the point where they’re going to need really expensive stuff like liver transplants.”

Yet because it’s impossible to determine which college bingers will moderate after graduation and who will go on to have lifetime problems, the distinction between abuse and dependence is difficult to pinpoint. The reality is that most college binge drinkers and drug users don’t develop lifelong problems. But most addiction treatment programs encourage them to see themselves as having a chronic, relapsing disease that requires a lifetime of attendance at 12-step meetings to keep in check. Currently, about 31% of college students meet criteria for “alcohol abuse,” while only 6% have the alcoholism-equivalent diagnosis of dependence.

Earlier editions of the DSM explicitly said there are alcohol and other drug problems that legitimately exist but do not reach the level of addiction; Alcoholics Anonymous itself differentiates between “problem drinkers” who can learn to moderate and alcoholics who can’t. DSM 5 obliterates the distinction. If the change is finalized, anyone whose drinking or drug use creates any problems will essentially be an addict or alcoholic with a “mild” case of the disease and presumably, therefore, not someone who can learn control over his habits.

While researchers have been encouraging the widespread adoption of “brief interventions” and other techniques that don’t require abstinence or a label— with great success— this change could swing the field in the opposite direction.

And that poses a huge problem, particularly for adolescents and young adults with mild problems who may be pushed to adopt an addict identity and to see themselves as having no way to control their drinking or drug use if they ever “relapse.” Rather than empowering those who do have control to use it, these programs essentially tell kids that if they ever have just one drink or puff on a joint, they’re lost.

While that strategy may help some people with addiction avoid relapse, research shows that it makes relapses worse if they do occur.  And given that the overwhelming majority of teens who are treated will not remain abstinent for life, this strategy is counterproductive for most who will be exposed to it.

In my years of covering addiction, I’ve heard the story dozens of times: someone with a mild problem enters treatment, is convinced they have a more severe case and meets others who help him or her get worse.  One teenage girl told me about meeting someone who turned her on to cocaine while in treatment for marijuana; another young man told me how treatment was the source of his perception that “who I was, was an alcoholic and drug addict.”

Clearly, treatment for young people already labels too many of them as addicts and alcoholics; the last thing we need is the DSM legitimizing this harmful practice.  It should rename substance abuse “substance misuse,” and label addiction, “addiction.”  From any perspective, it’s absurd to potentially label the 40% of college students who get drunk at least once a month as having “mild” alcoholism.

Read more at TIME Heartland

Psychologist and addiction expert offers a much-needed reality check about the benefits of drinking alcohol as well as its much more tangible drawbacks.

Binge drinking in college is out of control. About 90 percent of the alcohol consumed by underage kids in the U.S. is in the form of binge drinks. Each year, an estimated 696,000 college-age students are assaulted by a peer who has been drinking and 1,825 die from alcohol­-related incidents, including car crashes.

To curb this dangerous trend, new research shows that a reality check may be in order. After analyzing 19 separate alcohol expectancy challenges among more than 1,400 college students across the country, scientists at The Miriam Hospital found that challenging college students’ beliefs about the rewards of drinking can reduce both the quantity and frequency of alcohol consumption.

“If you believe alcohol gives you ‘liquid courage’ or that drinking helps you fit in or be more social, you’re likely to drink more,” says the study’s lead author, Lori A.J. Scott-Sheldon. “[But] if we can prove to students that many of the perceived positive side effects of alcohol are actually due to their expectations, rather than the alcohol itself, then we could potentially reduce frequent binge drinking and its negative consequences.”

---

Identify your alcohol expectancies. Create a list identifying how you think people feel and behave when they drink alcohol. You might be surprised to find out that many people focus on the positive effects of drinking alcohol (e.g., alcohol makes us have more fun, be friendlier, and feel more relaxed) and often fail to consider the negative effects of alcohol use (e.g., alcohol reduces my ability to think or concentrate, could cause me to get in trouble with the law). This is true even for people who have never consumed alcohol.

Understand the real effects of alcohol. When you drink small amounts of alcohol, you experience a “buzz.” People often feel mildly aroused, excited, and energized. Most people believe, as they drink more, they’ll continue to experience these positive effects but, since alcohol is a depressant, it slows down your central nervous system. Those initial positive feelings diminish over time as more alcohol is consumed. You begin to feel tired and your movements slow. If you drink more, you won’t regain that “buzz” but will only exacerbate these negative effects. Drinking excessively in a short amount of time may also lead to alcohol poisoning and death (PDF).

Consider how you learned about alcohol’s “positive effects.” Beliefs about the positive effects of alcohol predict future drinking behavior. Long before kids even begin to drink, they’ve already learned their alcohol expectancies from their parents, peers, and the media. The availability of alcohol and modeling of alcohol consumption at home (e.g., drinking to relax after work) affect children’s beliefs in the positive effects of drinking. Advertisements are also a significant source of children’s positive alcohol expectancies, since watching adults drinking and having fun promotes the positive effects of alcohol for kids.

Enjoy drinking without drinking any alcohol. Students often perceive heavy “binge” drinking (more than four servings for women, five for men on a single occasion) to be highly enjoyable because it’s often associated with partying and other social events. But it isn’t only the alcohol that causes the euphoria — it’s also the positive expectancies triggered by the social setting. In college bar experiments, where some students were led to believe they received alcohol, only half were able to identify if they really received alcohol. In fact, students who were given a placebo had just as good a time as the alcohol drinkers.

Have fun without drinking too much. There are many social activities you can enjoy without drinking. Go dancing, play games, or take in a movie to name a few. If you choose to drink, do so responsibly. Set your drinking limits before attending social events, keep track of your consumption, and alternate between alcohol and non-alcoholic beverages. Be prepared for potentially dangerous situations where high-risk drinking occurs. Find a friend you can trust to keep you safe from harm during a party and select a designated driver to keep you safe after.