DSM-5 Alcohol use Disorder Diagnosis Draws Controversy

Question

John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. He is the medical director at Alcohol Recovery Medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH). After more than a decade of revisions, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013 by the American Psychiatric Association (APA)-but not without controversy. The DSM-5 is widely used by health professionals to diagnose behavioral health problems and is used for insurance billing purposes. Several sections of the new DSM-5 have come under criticism, including the section dealing with alcoholism. In the previous version of the manual, Amazon Deals Fashion DSM-IV, published in 1994, alcohol use disorders were divided into two categories, alcohol abuse and alcohol dependence. In the fifth edition of the manual, AUD can be categorized as mild, moderate or severe. The diagnosis is based on 11 criteria.

The severity of the disorder is graded by the number of criteria the individual meets. From 0 to 1, the person does not have an AUD. From 2 to 3, the diagnosis is mild; from 4 to 5, moderate; and 6 or more, severe. According to the APA, a reason for combining the two separate diagnoses into one was primarily because the diagnosis of alcohol dependence caused confusion. Most people thought dependence meant addiction. Dependence, however, can be your normal body response to using a substance, such as when you become physiologically dependent on a medication while following your doctor's prescribed regimen. The craving criteria replaced a previous symptom of reoccurring legal problems due to drinking, which the APA eliminated because of varying cultural considerations that made the criteria difficult to apply internationally. According to the new criteria, a college student who binge drinks on weekends and occasionally misses a class would be diagnosed with a mild alcohol abuse disorder. This is part of where the controversy lies.

Critics say the revised criteria could lead to college or underage binge drinkers to be mislabeled as mild alcoholics, a diagnosis the could follow them into their later years. The task force that helped revise the manual claims the new criteria is a step in the right direction toward a more accurate diagnosis of the disorder. Dr. David Kupfer, chairman of the DSM-5 task force. One of the authors of the previous DSM-IV disagrees that research should be the only factor in diagnosis. Dr. Allen Frances, Amazon Deals chairman the DSM-IV task force. One 2013 study by researchers at Virginia Commonwealth University that studied 7,000 twins shows that the new criteria do not result in an improved alcohol-related diagnosis. The new criteria do not result in less accurate diagnoses either. Critics of the revisions claim the DSM-5 expands the list of what is considered mental illness and leads to a needless increase in diagnoses.

The most damaging criticism of the DSM-5 came from the National Institute of Mental Health (NIHM), which withdrew its support of the manual two weeks before its publication. The NIMH, the largest funding agency for mental health research, announced that it would be reorienting its research away from DSM categories. According to Dr. Thomas Insel, director of the NIMH when the manual was released, claimed that the main problem with the DSM-5 was validity. Meeting criteria does not go far enough to warrant a diagnosis. He said, "This would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever," implying that symptoms alone rarely indicate the best choice of treatment or an accurate diagnosis. The NIMH is in the process of developing its own Research Domain Criteria (RDoC) as an alternative to the DSM. It would find new ways of classifying mental disorders based on dimensions of observable behavior and objective neurobiological measures. Edwards, AC, et al. Alcoholism: Clinical & Experimental Research. Insel, T. "Transforming Diagnosis." National Institute of Mental Health.

 This con​te nt has ᠎be᠎en　w ritt᠎en ​by G SA Content Gen erat​or ​DE MO !

MAX BAYARD, M.D., JONAH MCINTYRE, M.D., feelingcutelol.com KEITH R. HILL, M.D., AND JACK WOODSIDE, JR, M.D. A more recent article on outpatient management of alcohol withdrawal syndrome is available. The spectrum of alcohol withdrawal symptoms ranges from such minor symptoms as insomnia and tremulousness to severe complications such as withdrawal seizures and howto.wwwdr.ess.aleoklop.atarget delirium tremens. Although the history and physical examination usually are sufficient to diagnose alcohol withdrawal syndrome, other conditions may present with similar symptoms. Most patients undergoing alcohol withdrawal can be treated safely and effectively as outpatients. Pharmacologic treatment involves the use of medications that are cross-tolerant with alcohol. Benzodiazepines, the agents of choice, may be administered on a fixed or symptom-triggered schedule. Carbamazepine is an appropriate alternative to a benzodiazepine in the outpatient treatment of patients with mild to moderate alcohol withdrawal symptoms. Medications such as haloperidol, beta blockers, clonidine, and phenytoin may be used as adjuncts to a benzodiazepine in the treatment of complications of withdrawal. ᠎Th​is conte nt w​as written by GSA C᠎onte​nt G ener​ator　Dem over​sion .