22 Dec 0
As I have discussed before, DSM 5 was released last year and contains some new concepts. There is no longer a category of Substance Abuse or Substance Dependence. (The term “substance” referring to alcohol, cannabis, opioids – prescribed or illicit – and benzodiazepines to name a few). Now, in its place, DSM 5 combines abuse and dependence into one category known as “Substance Use Disorder.” While both abuse and dependence have unique definable characteristics, my sense was that DSM 5 wished to see these disorders on a continuum and, to thereby help eliminate the question of when abuse become dependence – which at times can be difficult to discern.
The four criteria for the diagnoses of abuse were combined with the 7 criteria for dependence, with two criteria modified a bit. The result was an 11 point scale. Persons are now described as having “mild” Alcohol Use Disorder if they meet two or three of the eleven criteria, “moderate” if they meet four or five, and “severe” if they meet six or greater. However, the diagnoses of substance use disorder isn’t quite so easy as just counting criteria. DSM 5 defines substance abuse as “a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress.” Therefore, making the diagnosis still requires an accurate history and professional judgement.
The problem we face is that ICD 10, though new to us, has been around for twenty years – long before DSM 5. Therefore, it is important to know about the concept of Substance Use Disorder as it is now appearing in the medical literature. Next month I will discuss coding substance use disorder in ICD 10.