Terminology of substance use disorders for DSM-V

Starting with DSM III, the major substance use disorder categories have been called “abuse” and “dependence” in each successive version of the diagnostic manual. In DSM IV, the categories of abuse and dependence were designed to be non-overlapping entities where the dependence diagnosis supersedes abuse. In preparation for DSM-V, the substance disorders workgroup has taken up the challenge of considering alternative terminology. Because of the elimination of the categorical distinctions between abuse and dependence, the change in terminology takes on particular importance. In addition, potential confusion about multiple competing uses of the term dependence by DSM and pharmacologists (for whom the term dependence refers specifically to tolerance and withdrawal) has motivated the workgoup to consider alternatives. Following a series of conference calls and consultations, the workgroup considered three major alternatives for the name of the DSM-V Chapter on substance disorders and several alternatives for the main disorder (e.g. “dependence”, “addiction”, “substance use disorder”, etc.). Methods for studying the potential stigma and bias associated with different terminology will be reviewed, and the available findings presented. This presentation will review the major alternatives and provide an opportunity for the audience to participate in discussion about their strengths and weaknesses.