Whether we like it or not, each of us lives in an on-demand world where most anything you want to know about can be quickly accessed. And while that has obvious advantages, the other side of that coin is that same information is streamlined and simplified sometimes to our detriment.
DSM-5 will be the fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders. The new manual is due for publication in May 2013. In its latest version a big change is coming to how doctors diagnose and ultimately treat those with alcohol abuse problems.
In what will now be a single condition in DSM-5, ‘alcohol use disorder’ will take the place of two previous conditions ‘alcohol abuse’ and ‘dependence.’ The former is used for not–so-severe problems such as binge drinking while in college, or other short-term alcohol issues. I would hazard a guess that most adults who consume alcoholic beverages have been guilty of abusing booze a time or two in their life, and most of us are not alcoholics. The more severe of the two, and the one where its victims really need help is the ‘dependence’ diagnosis which is more in-line with hard-core alcoholism. The new diagnosis does come with varying levels of severity, but that means that potentially beginning in May fewer numbers of severe cases will be brought to light.
The APA with their revised definition has obliterated the medical distinction between problem drinking and alcoholism. This will likely lead to two problems: The first is the ‘binge’ drinker who drinks at parties or with his/her friends to excess may be labeled as an alcoholic, a stigma that can last a lifetime. The second, and honestly more dangerous problem are those who are dependent upon alcohol, and have an actual physical addiction to booze; these patients may not receive the medical care best for them because of the graying lines. About 40 percent of college students engage in binge drinking frequently enough that they might qualify for the diagnosis – but a much smaller 5 percent of graduates are labeled as alcoholics after age 26. The numbers dwindle.
Led by Alexis Edwards of Virginia Commonwealth University, researchers studied more than 7,000 fraternal and identical twin, to see if the new simplified singular diagnosis in DSM-5 would alter alcohol-related diagnoses, compared to DSM-4. The subjects responded to questions about loss of control over drinking, trying and failing to cut down or quit, and hazardous behavior that doctors commonly use to define alcohol problems.
"It is not clear that the proposed diagnostic changes will result in a more accurate diagnosis," the study's authors write. "At best, one group of low severity cases will be replaced by another; at worst a group of individuals who exhibit more severe problems will be excluded from the DSM-5 diagnosis, while less severely affected individuals will meet diagnostic criteria."
In an earlier study it was found that the new criteria in DMS-5 would increase the number of people classified as having alcohol problems by nearly 62% over DSM-4. The new version will include more people with mild problems which were not seen as significant enough to warrant a psychiatric label in the past. These are the patients who could be labeled as alcoholics or suffering from alcoholism who, in reality only have a binge drinking problem.
When a broad brush is used to label a problem or anything for that matter - the individual can become lost in the shuffle. When that happens, there is less the treatment of an individual patient and more of a generic treatment plan.
It is lazy healthcare.
"Diagnoses made casually and based on insufficient evidence can stick with someone for life, causing needless stigma and affecting job and insurance opportunities long after the substance problem has resolved," Dr. Allen Frances, professor emeritus of psychiatry at Duke and former chair of the DSM-IV task force that wrote the earlier edition."Many young people who get into early trouble because of substance abuse never become dependent and shouldn't be lumped together with long term addicts."
In the United States there are currently 15 million people who are abusers of alcohol or dependent upon it. Alcohol is estimated to be the cause of death between 20 and 30 percent of the time in homicides, motor vehicle accidents and Epilepsy. Alcoholism is a very serious and dangerous addiction. If you or someone you love needs help please call Alcohol and Drug Abuse Hotline at 1-800-729-6686.
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