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This month, just before its annual meeting last week in Honolulu, the American Psychiatric Association (APA) released the current draft of the fifth edition of its diagnostic "bible," the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). As in previous proposals, the terms "dependence" and "abuse" will disappear, and those two categories--which are separate under DSM-IV-R, will be replaced by a new category, "substance use and addictive disorders." There is also a new criterion for "craving."
The elimination of the distinction between abuse and dependence is "far and away the most important change," Wilson M. Compton, M.D., a member of the DSM-5 task force and an active participant on the substance use disorder workgroup of DSM-5, told ADAW last week.
Compton, who is also director of the Division of Epidemiology, Services and Prevention Research at the National Institute on Drug Abuse (NIDA), told ADAW that the new criteria will make it possible for clinicians to determine the severity of the disease by the number of criteria someone has. "If someone has just two symptoms, they'll get a diagnosis, but it will be inherently milder than someone who has 10," he said. (see sidebar on page 3 for the criteria for substance use disorders.)
Two other changes cited by Compton include the addition of cannabis withdrawal as a diagnosis …