Transcript Why Not Use the DSM-IVR for Diagnosing Addiction?

Why Not Use the DSM-IVR for
Diagnosing Addiction?
Reason #147: Inadequacies of using qualitative
indices for a quantitative problem
DSM-IV Classification of Addiction
• DSM does not use the term addiction
• Same concept is described under substance
dependence disorder
DSM-IV Criteria
A maladaptive pattern of substance use leading to clinically significant
impairment or distress as manifested by three (or more) of the
following, occurring at any time in the same 12-month period:
• Substance is often taken in larger amounts or over longer
period than intended
• Persistent desire or unsuccessful efforts to cut down or
control substance use
• A great deal of time is spent in activities necessary to
obtain the substance (e.g., visiting multiple doctors or
driving long distances), using the substance (e.g., chain
smoking), or recovering from its effects
• Important social, occupational, or recreational activities
given up or reduced because of substance abuse
DSM-IV Criteria, continued
• Continued substance use despite knowledge of having a
persistent or recurrent psychological, or physical problem
that is caused or exacerbated by use of the substance
• Tolerance, as defined by either:
– (a) need for increasing amounts of the substance in order to
achieve intoxication or desired effect; or
– (b) markedly diminished effect with continued use of the same
amount
• Withdrawal, as manifested by either:
– (a) characteristic withdrawal syndrome for the substance; or
– (b) the same (or closely related) substance is taken to relieve or
avoid withdrawal symptoms
Is Sasha Addictive?
You have to meet her to understand.
Meet Sasha
DSM-IV Criteria Met
Substance is often taken in larger amounts or over longer
period than intended
 She takes a lot more time than originally anticipated
DSM-IV Criteria Met
 Substance is often taken in larger amounts or over longer
period than intended
Persistent desire or unsuccessful efforts to cut down or
control substance use
 She successfully resists attempts to decrease her high
maintenance and become more self-sufficient (e.g., play by
herself, eat dog food)
DSM-IV Criteria Met
 Substance is often taken in larger amounts or over longer
period than intended
 Persistent desire or unsuccessful efforts to cut down or
control substance use
A great deal of time is spent in activities necessary to
obtain the substance (e.g., visiting multiple doctors or
driving long distances), using the substance (e.g., chain
smoking), or recovering from its effects
 Very high maintenance, e.g., trips to the vet, trips to Pet store,
food preparation, poop-n-scope, maintaining her rolling dog
house
DSM-IV Criteria Met
 Substance is often taken in larger amounts or over longer
period than intended
 Persistent desire or unsuccessful efforts to cut down or
control substance use
 A great deal of time is spent in activities necessary to
obtain the substance (e.g., visiting multiple doctors or
driving long distances), using the substance (e.g., chain
smoking), or recovering from its effects
Important social, occupational, or recreational activities
given up or reduced because of substance abuse
 Radical change in life style
Four DSM-IV Criteria Met
 Substance is often taken in larger amounts or over longer
period than intended
 Persistent desire or unsuccessful efforts to cut down or
control substance use
 A great deal of time is spent in activities necessary to
obtain the substance (e.g., visiting multiple doctors or
driving long distances), using the substance (e.g., chain
smoking), or recovering from its effects
 Important social, occupational, or recreational activities
given up or reduced because of substance abuse
Might as well admit it you’re addicted to love.
—Robert Palmer
So Is Sasha Addictive?
• Probably not
– problem with “where to draw the line” (i.e, applying
qualitative criteria to a quantitative problem)
– even if the behavior is viewed as additive, it represents
an interaction (Sasha [Cavalier King Charles Spaniel] x
personality traits [prof.]) and not an attribute of Sasha
• perhaps self-medication?
• no justification to regulate availability of “Sashas”
But She’s Still Cute
Sasha rules!