the DSM-5

Question 1

DSM 4-

Answer 1

differentiated between substance abuse and substance addiction

Question 2

new disorder in DSM5-

Answer 2

substance use disorder

Impaired Control:
(1) Used larger amounts/longer;
(2) Repeated (unsuccessful) attempts to quit/control use;
(3) Much time spent using;
(4) Craving
Social impairment:
(5) Neglected major roles (e.g., work, school, home) to use
(6) Continued use despite social or interpersonal problems related to use
(7) Activities given up to use
Risky Use
(8) Hazardous use
(9)Physical/psychological problems related to use
Pharmacological criteria
(10) Withdrawal
(11) Tolerance

Two or more substance use
disorder criteria within 12-
months for a diagnosis.
§ Mild
§ Moderate
§ Severe

Classes of drugs covered
Alcohol
Caffeine
Cannabis
Hallucinogens
Inhalants
Opioids
Sedatives
Hypnotics and anxiolytics
Stimulants
Tobacco
Other
each with specific criteria for each class

Classes of drugs covered
Alcohol
Caffeine
Cannabis
Hallucinogens
Inhalants
Opioids
Sedatives
Hypnotics and anxiolytics
Stimulants
Tobacco
Other

Question 3

changes from DSM 4 TO DSM5

Answer 3

1. Nomenclature changed from “Substance-abuse” and “Substance dependence” to “Substance
   use disorders” in DSM-5. Terms ‘abuse’ and ‘dependence’ were removed from DSM-5.
2. The term ‘addiction’ has been removed from DSM-5 due to potentially negative connotations.
3. Removal of legal problems criteria; addition of craving.
4. Threshold set at 2 or more criteria (versus 1/3 in DSM-IV).
5. Inclusion of cannabis withdrawal and caffeine withdrawal as new disorders.
6. Guidance around severity (# of criteria endorsed) and remission status (3-12months; 12mo +).
7. Inclusion of one behavioural (i.e. non-substance related) disorder (gambling). Previously
   classified within the ‘impulse-control disorders, not otherwise specified’ in DSM-IV.
8. DSM-5 points to the potential of other non-substance related disorders for inclusion in future
   versions of the DSM.

Question 4

expansion of behavioiural addictions

Answer 4

§ Shift from central role of neurobiological
features of addiction, to addiction as a
conditioned behaviour.
§ Potential expansion to include other behaviours
associated with excessive reward seeking.
§ Potential overlap in terms of phenomenology
(craving, tolerance, withdrawal), onset,
chronicity, relapse, comorbidity, genetic
overlap, neurobiology and response to
treatment.
§ Overlap in consequences (psychological
distress, physical impairment, social,
interpersonal, occupational functioning).

Question 5

risks of adding behavioural addictions

Answer 5

o Terminology around ‘addiction’
o Proliferation of psychiatric conditions can
undermine the legitimacy of the wider field
o Difficulties in distinguishing true mental disorders
from just ‘high levels of normal behaviour’.
o Scientific rigour needed in determining quality and
quantity of evidence for consideration of inclusion in
the DSM.
oSociety’s role in determining behavioural addictions

Question 6

requirement for new disorders

Answer 6

American Psychiatric Association (2013)
Fulfil a clinical need
Reflect an underlying psychobiological disturbance
Contribute to better assessment and treatment
Sufficiently distinct from existing disorders
Diagnostic validity
* Emphasis on research evidence
* Continuity with existing manual is important
* “Implementable” via routine clinical practice
* Understanding the risks to introducing the
change (or not) to individuals.
* Section 3 of the manual – “Conditions for
Further Study”.