The field of psychology has been extensively researched and tested, and that includes the diagnostic criteria that therapists use to guide treatment plans. We use the Diagnostic and Statistical Manual (DSM) as a way to identify specific psychological challenges based on their characteristics, and use that information to help determine whether or not the patient would benefit from treatment.
But as invaluable as the DSM has been, it can also be limiting. One example of this is addiction. The DSM-V requires the following criteria in order for a patient to be diagnosed with addiction (in this case, substance use disorder):
- The substance is often taken in larger amounts or over a longer period than intended.
- There is a persistent desire or unsuccessful efforts to cut down or control substance use.
- A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
- Craving, or a strong desire or urge to use the substance.
- Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
- Important social, occupational, or recreational activities are given up or reduced because of substance use.
- Recurrent substance use in situations in which it is physically hazardous.
These are only some of the criteria the DSM-V uses to diagnose addiction. It also tells a very incomplete story.
What the DSM-V Leaves Out
As valuable as these models can be for diagnoses, one challenge they have is that they leave out a lot of subjectivity:
- They leave out how the person feels about their addiction and the distress it causes, and whether or not they want help for it no matter if it falls under these categories.
- They leave out how dire the consequences will be if the addiction gets out of control. For example, if it is a highly addictive, highly dangerous substance but is not currently impacting their life, we know that it could eventually.
- They leave out the context in which the behavior occurs, such as if the desire to use the substance is due to outside factors (implying outside factors are the real issue) or if it is being used in a reckless environment.
The DSM-V is a great tool, especially during training, to make sure that someone knows generally how to diagnose mental health issues. Its details on addiction also are capable of covering most diagnoses of addiction. But there is also no denying that a lot depends on the particular nature of the individual.
Working With Patients Based on Who They Are
One of the reasons it is problematic for the DSM-V to be limiting is because many insurance agencies and hospitals have requirements that must be met before they can start treatment, and one of those requirements is a clear and accurate diagnosis according specifically to the DSM. If they do not have this qualification (or they do, but there is an argument that they do not have a true addiction), then it affects the ability of therapists to provide the proper treatment.
While there is no denying that the DSM is a net advantage, there are arguments to be made that the mental health treatment world needs to reconsider how it addresses mental health issues. Contact Long Island Psychology today for more information about addiction treatments on Long Island.
