New approaches to diagnosing substance use disorders in DSM-V

The DSM-V Substance Related Disorders Workgroup was charged with making improvements on previous diagnostic criteria that were data-based, that moved the classification towards clinical neuroscience and, above all, improved the system's utility for clinicians. The proposed changes are consistent with these goals and are on schedule for a 2012 publication. Each speaker will address one area of major change that is under consideration for DSM-5. One topic is the accumulated body of research indicating that the two diagnostic categories, “abuse” and “dependence”, are not sufficiently distinct for any substance to warrant continued separation of the diagnostic criteria into two hierarchical disorders. Related to this topic are the questions of whether craving should be added as a diagnostic criterion, and whether any of the criteria, particularly legal problems, can be removed. A second topic is whether the criteria for nicotine use disorders, up to now including only nicotine dependence, can be aligned with the new criteria set for the other substances to include abuse criteria and craving. A third topic is the appropriate terminology to use in referring to the disorders of principal interest in this section of the DSM-5. A final topic is whether the data support incorporation of non-substance compulsive or addictive behaviors such as gambling disorders into the DSM-5 chapter that previously only included disorders involving maladaptive use of psychoactive substances. The speakers will address these issues, providing an overview of the DSM-5 workgroup activities and an opportunity for conference participants to discuss and provide feedback.