By: Charles O’Brien
From: Addiction. Vol. 106, Issue 5, pages 866-867, May 2011
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Keywords: Addiction, dependence, pain, tolerance, withdrawal
Members of the academic community who might be confused about revisions for the fifth edition of the Diagnostics and Statistics Manual of Mental Disorders, which is the American Psychological Association’s primary reference manual.
The author explains certain changes from the DSM-IV to the DSM-5, primarily for its sections on substance-related disorders and dependence.
Historically, the main point of contention lies with the history of the terms “addiction” and “dependence”. For the DSM-III Task Force in 1980, “Addiction” was considered, by non-clinicians, to be a pejorative, to be something that people did not want to be associated with and would therefore alienate people with this label. So non-clinicians prefered the term “dependence”. However, clinicians argued that “dependence” already had a meaning in normal clinically-prescribed drug use, and by using this term instead of “addiction”, they could cause confusion. “Dependence”, the clinicians argued, is a normal physiological response to medication. “Addiction” implies a problematic, drug-seeking behavior that negatively impacts one’s life. Despite this semantic disagreement, they made the change for the DSM-III, which made its way into the DSM-IV.
This change led to physicians under-utilizing opioids because of the fear that people would become “dependent” on them, even though the term “dependence” in the DSM-III/IV meant “addiction”, not dependence. “Addiction” traditionally implied problem behavior, not just the trait of feeling desire for a substance.
For the DSM-V (later changed to DSM-5), there would be a separate section called “Addiction and Related Disorders” that would also include “Gambling disorder” as a behavioral addiction. They would also make the distinction between clinical dependence by calling what lay people would call “addiction” as “substance use disorder”. So now “addiction” is called “substance use disorder”.