Changes in the DSM 5

changes in the DSM 5

The DSM-5, short for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the latest update to the American Psychiatric Association’s (APA) classification and diagnostic tool. It is used for diagnosing psychiatric disorders and also makes treatment recommendations for these disorders. Because there is always new research and findings in the medical field and especially in regards to psychological illnesses and disorders, there are changes in the DSM 5.

The DSM is like an encyclopedia of mental illness concepts and definitions, which change over time. Therefore the changes in the DSM 5 can be seen in this current version – the fifth edition, published on May 18, 2013.

Changes in the DSM 5: Substance Use and Addictive Disorders

The first noticeable difference to the section on substance use and addictive disorders is that it is laid out differently.  Whereas previously organized according to the diagnosis, such as use, intoxication, and withdrawal, new changes in the DSM 5 reflect chapter order and numbering that is designated according to the specific substance.

Changes in the DSM 5: Substance-Related and Addictive Disorders

Some major and apparent changes in the DSM 5 are that gambling disorder and tobacco use disorder are now recognized. Also, criteria for marijuana (cannabis) and caffeine withdrawal were added.

A new “addictions and related disorders” category combines substance abuse and substance dependence into single substance use disorders specific to each substance of abuse.

Instead of the term of “recurrent legal problems” as part of the criteria, changes in the DSM 5 now use “craving or a strong desire or urge to use a substance” in the diagnostic criteria. The DSM 5 also uses a spectrum of severe-to-mild; severity from mild to severe is based on the number of criteria endorsed. And the threshold of the number of criteria that must be met was changed.

Other Changes in the DSM 5

  • Hallucinogen Disorders have now include Phencyclidine (PCP) Disorders
  • Sedative, Hypnotic, or Anxiolytic Disorders now called Sedative/Hypnotic-Related Disorders
  • Amphetamine and Cocaine Disorders now called Stimulant Disorders
  • Removal of Substance-Induced Dissociative Disorder
  • Minor wording changes to most of the criteria
  • Added criteria for Hallucinogen Persisting Perception Disorder
  • Added criteria for Neurobehavioral Disorder Associated With Prenatal Alcohol
  • Added criteria for Caffeine Use Disorder
  • Added criteria for Internet Use Disorder
  • Added criteria for Drug Specific “Not Elsewhere Classified” diagnoses

Concerns Regarding the Changes in the DSM 5

Because of the re-structuring that is based on the specific substance, there are concerns that first-time substance abusers will be lumped in with hard-core addicts. This is problematic because of their very different treatment needs and prognosis as well as the stigma this may cause.

Changes in the DSM 5 have also created a slippery slope by introducing the concept of Behavioral Addictions (i.e. gambling, internet, sex) that eventually can be used to make everything we enjoy doing a lot into a mental disorder. There is concern that this sort of thing can lead to careless over-diagnosis of internet and sex addiction and result in the development of lucrative treatment programs to exploit these new markets.








How to Help a Chronic Relapser

How to Help a Chronic Relapser

What is a Relapse?

Relapse is resuming the use of a drug or a chemical substance after one or more periods of abstinence; a recurrence of symptoms of a disease (addiction) after a period of improvement; to slip or fall back into a former worse state (active addiction).

What is a Chronic Relapser?

Many addicts have a lifetime of drug and alcohol abuse but have never actually attempted to get sober. What makes chronic relapsers distinct is that they have tried and failed at maintaining sobriety many times over.

Profile of the Chronic Relapser

  • Numerous failed attempts at sobriety, or a return to drugs/alcohol after a substantial period of sobriety
  • Unable to maintain sobriety despite having a wealth of knowledge about addiction and recovery
  • Continued substance use despite significant, severe and repeated consequences
  • Chronic relapsers often feel hopeless that they will ever find lasting sobriety
  • Multiple treatment episodes, including psychiatric treatment, detox, residential, outpatient, and halfway houses
  • Significant exposure, attendance and/or participation in 12-Step programs. Chronic relapsers have a history of repeatedly working Steps 1, 2 and 3, but have never completed all 12
  • Treatment-savvy have learned to navigate their way through the treatment industry to meet their own agenda
  • A unique talent to exhaust the financial resources and emotional support of loved ones. Chronic relapsers leave their loved ones depleted of energy and emotional resources
  • As with most addicts, a pervasive cluster of personality characteristics are frequently exaggerated in the chronic relapser; they are very charming, intelligent, manipulative, convincing, deceitful, lovable, talented and passionate; chronic relapsers have mastered the art of survival, in and out of treatment.

How to Help a Chronic Relapser

Below are ways to get involve, support, and encourage successful recovery for a chronic relapser.

Encourage a long-term length of stay. It is a well-established fact that long-term treatment increases the chances of lasting sobriety. It is important to define the term “long-term treatment” as in a length of stay in excess of nine months. It can take a chronic relapser three to six months to wake up out of the fog in which they have been living. Post-acute withdrawal syndrome (PAWS) is very significant in chronic relapsers and frequently interferes considerably with their ability to comprehend recovery principles in early sobriety.

Remove outside distractions. Chronic relapsers are masters at distracting themselves and others from seeing the truth about them. It is essential to remove all things they use to change the way they feel and to force them to sit in their own skin.  It is well within the boundaries the treatment center to limit distractions through therapeutic contracts, clear-cut facility rules and guidelines, and limited family contact. As a loved one or family member of a chronic relapser, be aware that you may be asked not to visit early on or often throughout treatment.

Emphasize the mental and spiritual nature of the disease. It is essential that chronic relapsers understand they have a disease of the mind body and spirit, and that the solution through the 12 Steps is spiritual in nature.

Be active in getting your own treatment. In most cases, the family has participated in the progression of the illness in the chronic relapser through intense enabling behaviors. Therapy for the family cannot just be a suggestion; it must be non-negotiable. Get involved with Al-Anon or Nar-Anon and consider counseling for yourself and other family members.

Put an end to enabling. Family leverage is usually the most significant in keeping a chronic relapser in long-term treatment. Chronic relapsers must recognize in no uncertain terms that they will not receive any emotional or financial support from their family if they do not complete long-term treatment or remain sober.

Stay one step ahead. It has been established that chronic relapsers are treatment-savvy, tricky and highly manipulative. When you, as the family, do get to speak and/or visit the chronic relapser, don’t take what they say at face value. Don’t give them an inch.

Emphasize that they work all 12 Steps with a sponsor. It is important that working the 12 Steps is not just a suggestion, but a requirement. These individuals must be held accountable to obtain a sponsor and work all 12 Steps while they are still in treatment.

Be relentless with accountability. Treatment for the chronic relapser should include a constant emphasis on accountability, responsibility and consistency. It is essential that there be rules, limits, boundaries and consequences with chronic relapsers. Family and friends can support but knowing what is expected of their loved one and reinforcing these policies and practices in their encounters with the chronic relapser.