The ARM-ME blog brought to my attention today that the first draft of the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) has been released. This is the guide published by the American Psychiatric Association that provides standard criteria and terminology to be used by doctors to diagnosis their patients… and much, much more. It will legitimize conditions and qualify them for insurance payment while confusing other issues leading to denial of coverage. It will help in reducing the stigma of certain conditions and stir up controversies that will lead to new discrimination. It will also be used as a perverted support in cases of convenient victimization and the rationalization of unacceptable behavior. It can be a milestone for improving the quality of life for thousands and yet will surely lead to over-diagnosing, over-prescribing, and the repercussions that follow.
Relative to TDA, there will be significant changes in the way the new DSM categorizes addiction and dependence. I find it mildly disturbing that the article referenced by the ARM-ME blog has a few comments by Stanton Peele, who it seems over the years has juggled the use of these terms solely on the basis of what will best further his career or increase book proceeds. An anonymous responder to a recent Stanton Peele article in Psychology Today raises this very point.
My point remains that Mr Peele holds himself out as a medical authority and is advising people with active alcohol problems that they alone can control the issue. He tells them what they want to hear. The sad fact is that those most at risk are also the most likely to heed his advice. Mr. Peele knowingly blurs the line between problem drinker and alcoholic and then provides generic unfounded advice… Mr Peele makes his living pushing his moderation mantra. If you look at his other web sites you will see he is pushing his own recovery program for people to pay him.
Good thing the final draft will not be complete until 2013 and only after a thorough peer review. In the end though, I doubt seriously there will ever be a good definition for addiction since it is such an encompassing affliction that very few professionals ever look beyond their specialty or discipline to get the bigger picture.
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You know, I never even considered the aspect of “using the book to legit unacceptable behaviors”…or to get people out of things they probably should be held accountable for. I, naively, was just happy to finally have the word “addiction” back in the DSM (replacing the term DEPENDENCE)…but other than that, I honestly didn’t give the book much thought!
Well no, wait! Lol that isn’t true! I worked for 7 years as an office manager at a small outpatient substance abuse counseling center…where we did individual, group, family and IOP counseling. The DSM ruled our world back then, because the only way we could get PAID for what we did, is if we gave the person seeking help the diagnosis their particular insurance carrier “deemed” appropriate for our “level” of care. WHAT A NIGHTMARE! Insurance parity is a deep seeded issue that doesn’t end just with us getting coverage for treatment, that is for sure!
I would like to say that we diagnose both mental illness, addiction and physical illness based on what the expert analyzing the disease felt was best–but I now work as a medical laboratory technologist-and believe me, what the insurance company will pay for comes into play far too much when it comes to diagnosing ANY illness.
Anyway–thank you for giving me something else to consider. What a convoluted world we live in!
Kristan Hilchey
ARM-ME