By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
New ways of seeing addiction, substance abuse, and related problems.
Substance-Related and Addictive Disorders forms one chapter in the DSM-5 and reflects some shifts in the way people are thinking about both substances and addiction. Keep in mind that the APA who writes the DSM are Psychiatrists, medical doctors, and they tend to see these issues from a medical perspective. Substance Abuse or addiction counseling grew up as a distant step-child from the medical community and the two are still not in agreement on many of these issues.
Counselors and talk Therapists are likely to emphasize the emotional and behavioral consequences of drug and alcohol use and other behavioral “addictions.” Doctors emphasize the physical issues. Psychiatrists straddle this line but their primary method of treatment is prescription while the counselors are using talk therapy, behavioral modification, and support groups.
The DSM-5 lists 10 “classes” of drugs.
Any effort at classification ends up being a bit problematic. The DSM-5 reduced the list of categories from the eleven we had in the DSM-IV-TR to ten. It notes that these classes are “not fully distinct.” They are listed in alphabetic order so Caffeine-Related Disorders comes after Alcohol-Related Disorders. For Substance Use Disorder treatment, counselors often use some very different ways of classifying a client’s substance use. More on that in other counselorssoapbox.com posts.
What are the problems the substance is causing?
Each substance listed in the DSM-5 has sections for about 4 more or less different issues that this substance may be causing. Let’s use Alcohol for ease of explanation.
Someone may develop an “alcohol use disorder” and be referred for treatment of their drinking. The issue the counselor will be treating will be the client’s risky pattern of drinking that may include DUI’s, DWI’s, arrests, family conflicts, loss of a job, or even physical problems. The principle issue from the counselor and the client’s point of view is the client’s inability to reduce or control their drinking, the presence of cravings, and their use even when they know it is causing problems.
Substances can hurt you even if you do not take them intentionally.
The DSM includes provisions for the medical practitioner to diagnose and code problems related to substances that a counselor is unlikely to treat. Lead poisoning is a serious medical problem, so are the side effects of prescribed medications. Neither of those is something the counselor is likely to treat.
What problems might a substance cause someone?
- A substance use disorder where their use is out of control or they have carvings.
- Intoxication, the effects that we see while they are under the influence.
- Withdrawal. Unusually withdrawal effects are the opposite of intoxication. Stimulants keep you awake and withdrawal from stimulants will involve being tired and sleeping a lot.
- Substance-induced disorders. These are medium to long-term changes that are the result of exposure to a substance that persists even after the drug has left the client’s system.
What are the 10 listed drugs?
- Cannabis (Primarily Marijuana)
- Opioids (Heroin and RX pills)
- Sedatives, Hypnotics, and Anxiolytics.
- Stimulants. (This combines Cocaine and Amphetamines, the DSM does not separate Meth from other amphetamines the way substance abuse treatment does.)
- Other or Unknown Substance Use Disorder
Towards the end of the Substance-Related and Addictive Disorders chapter, there is a section for “Non-Substance-Related Disorders. That section includes a single entry for Gambling Disorder. In counseling work, we see things we may conceptualize as behavioral addictions, sexual and pornography addictions for example. These are not a part of the DSM-5 Non-Substance-Related Disorders section.
The Substance-Related and Addictive Disorders chapter shifts the focus.
We used to spend a lot of time arguing about the differences between addiction and substance abuse. People with a DUI would tell us they did not need treatment. Now the DSM largely drops these labels and if you have any problem with a substance that becomes a substance use disorder. We rate the use disorder as mild, moderate, and severe.
Remember that the Substance-Related and Addictive Disorders are listed in the “Diagnostic and Statistical Manual of Mental Disorders and these are largely considered treatable mental illnesses. The medical issues have other codes and are outside the scope of practice of a counselor, though we may need to help them adjust to the consequences of their medical issue. Watch for more posts on these other related issues.
As with the other things we are calling a mental illness these Substance-Related and Addictive Disorders need to interfere with your ability to work or go to school, your relationships, your enjoyable activities, or cause you personal distress. Otherwise, you may have the issues but you will not get the diagnoses if this is a preference, not a problem.
FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.
You might also want to check out these other counselorssoapbox posts.
Staying connected with David Joel Miller
Seven David Joel Miller Books are available now!
My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.
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