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Recently psychiatrists and other specialists are rewriting the manual that serves as the nation’s “go to” guideline for mental illness. The reason for this rewrite is simple; to change the definition of addiction. This may seem like a simple task but it may have more far reaching consequences than most believe. Rewriting the definition of addiction in what is known as the Diagnostic and Statistical Manual of Mental Disorder, or DSM, could result in more individuals being diagnosed as addicts and could therefore have big impacts for health insurers and us as taxpayers.

The rewriting of the definition of addiction would increase the list of symptoms for drug and alcohol addiction while also lowering the number of symptoms needed to make a diagnosis. In addition to the change in the list of symptoms for the definition of addiction the DSM manual would also, for the first time ever, include gambling as an addiction along with a category known as” behavioral addiction-not otherwise specified” that would include diagnosis of addictions to shopping, sex, internet use and playing video games.

The DSM manual has for a long time been the arbiter for the government and medical industry. The DSM manual dictates whether insurance companies have to pay for treatment and whether or not schools will spend money for certain special-education provided services. The broader terms used in the definition of addiction, which was up for debate this past week at the association’s annual conference, intends to promote more accurate diagnoses, earlier interventions and better outcomes, the association said. “The biggest problem in all of psychiatry is untreated illness, and that has huge social costs,” said Dr. James H. Scully Jr., chief executive of the group.

The revisions to the definition of addiction in the DSM manual are scheduled to be in effect by next May and it has already instigated a wide debate of concerns. People worry that the changes to the definition of addiction would severely alter the number of individuals diagnosed as addicts. Under the new definition of addiction, individuals who may drink more than intending to and have cravings for alcohol may be considered mild addicts. According to the old definition of addiction the diagnosis has to include serious symptoms such as; missing work repeatedly, driving under the influence, or getting arrested.

The association says that the definition of addiction changes would lead to healthcare savings in the long run, some economists’ say that 20 million substance abusers could suddenly become categorized as addicts and that would cost hundreds of million dollars in extra expenses. The savings from early intervention due to the new definition of addiction will usually show up within a year, Dr. Humphreys said, and most patients with a new diagnosis would get consultations with nurses, doctors or therapists, rather than expensive prescriptions for medicines typically reserved for more severe abusers.

Although, some critics of the money savings, believe that the revision of the definition of addiction, in the new DSM manual, has been motivated by researcher’s ties to pharmaceutical companies. For instance the makers of medicines to help with drug and alcohol cravings would benefit from the new definition of addiction including cravings for alcohol or drugs.

As Dr. Humphreys said, “This represents the single biggest expansion in the quality and quantity of addiction treatment this country has seen in 40 years.” This may allow an additional 30 million people who abuse drugs or alcohol to get insurance coverage for treatment or it may end up diagnosing many people as addicts who may not necessarily have a real problem. We will have to wait and see.


Source: NY Times





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