Current diagnostic guidelines for substance use disorder, created in 2013 by the American Psychiatric Association, have a high level of dependability in most cases, new findings from an American research group indicate.
In 2013, the American Psychiatric Association created the substance use disorder diagnosis and essentially abolished the distinction between substance addiction and dysfunctional, non-addicted substance abuse. In a study published in May 2015 in the journal Drug and Alcohol Dependence, researchers from three U.S. institutions compared the reliability of the substance use disorder diagnosis to the reliability of the previously separate diagnoses for substance addiction and substance abuse. These researchers concluded that the new diagnosis is dependable, particularly for those individuals with moderate or severe substance problems.
Substance Abuse and Substance Addiction
The American Psychiatric Association distributes definitions for all officially diagnosable mental health problems in a periodically updated text called the Diagnostic and Statistical Manual of Mental Disorders, or DSM. Prior to 2013, the DSM required the presence of at least one out of four possible symptoms in order to make a diagnosis of substance abuse. These symptoms included repeated use of the substance in question in clearly dangerous circumstances, a repeated and substance-related inability to meet daily responsibilities or obligations, continued involvement in substance use after exposure to serious substance-related harm and repeated exposure to legal consequences of substance use.
Prior to 2013, the DSM required the presence of at least three out of seven possible symptoms of substance addiction before doctors could make a diagnosis. The symptom list included rising tolerance to the effects of the substance in question, an inability to set and/or enforce limits on substance intake, devotion of large amounts of time to substance-related issues, a substance-related inability to take part in preferred or important activities, the onset of withdrawal symptoms in the absence of the substance in question and continued substance use in the face of known physical or psychological harm.
Substance Use Disorder
Research and real-world doctors’ experiences have consistently shown that a person who meets the criteria for separately diagnosable substance abuse can also meet the criteria for separately diagnosable substance addiction. Before 2013, this fact often left doctors in the uncomfortable position of having to decide which disorder to officially identify in some of their patients. However, with the creation of the substance use disorder diagnosis, the American Psychiatric Association pooled the definitions for substance abuse and substance addiction, and thereby eliminated the need to make an “either/or” diagnosis for affected individuals. There are 11 possible symptoms of substance use disorder; with the exception of the now-eliminated criterion for substance-related legal problems, these symptoms are largely the same as those associated with separately diagnosable substance abuse and separately diagnosable substance addiction. Mildly affected individuals have two or three symptoms of the disorder, while moderately affected individuals have four or five. Doctors declare the presence of severe substance use disorder in people with six or more symptoms of abuse/addiction.
In the study published in Drug and Alcohol Dependence, researchers from the University of Pennsylvania, Yale University and the Philadelphia VA Medical Center used data drawn from 173 adults to test the reliability of the substance use disorder diagnosis for people with alcohol, cocaine, cannabis or opioid-related abuse/addiction issues. All of the study enrollees took part in extensive interviews based on the current American Psychiatric Association definition for substance use disorder, as well as extensive interviews based on the old definitions of substance abuse and substance addiction. The researchers compared the results of these interview sessions for each individual. They also assessed the impact of diagnoses for multiple types of substance problems, as well as the impact of overlapping problems with other mental health issues.
The researchers ultimately concluded that the modern diagnosis of substance use disorder is essentially dependable for problems related to alcohol, cocaine, cannabis or opioid intake. Generally speaking, people dealing with moderate or severe problems with these substances have a higher chance of receiving an accurate diagnosis than people dealing with mild problems. The researchers concluded that the presence of multiple substance problems in a single individual makes it somewhat harder to produce an accurate substance use disorder diagnosis. They also concluded that the simultaneous presence of a depressive disorder, a bipolar disorder or an anxiety disorder can make it more difficult to accurately diagnose substance-related issues.