Addiction affliction: Psychiatrists create a stir with broad definitions

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It is often said, on everything from oil to junk food, that we're a nation of addicts. That adage will have greater meaning if the American Psychiatric Association adopts broad new definitions of addiction next year in the manual that shapes the nation's approach to mental illness.

The Diagnostic and Statistical Manual of Mental Disorders is undergoing revision, and one part to come under fire is a proposed expansion of the list of symptoms for drug and alcohol addiction. Critics fear that the looser language could mean millions more people being classified as addicts, thereby creating expensive consequences for health insurers and the public.

The association would be wise to reconsider its proposals.

The New York Times reported that the new manual, which will be published in May 2013, would list gambling as an addiction for the first time and might include the broad new category of "behavioral addiction -- not otherwise specified." Some public health experts, according to the Times, fear that classification could be overused by doctors to diagnose patients with addictions to the Internet, video games, shopping or sex.

The biggest controversy, however, is over how the proposal recasts drug and alcohol addiction. The current definition requires serious outcomes like being arrested, driving under the influence or missing work or school for a person to be diagnosed with alcohol abuse. The new approach views addiction as a continuum, with those displaying at least two less-problematic behaviors, such as craving alcohol or drinking more than they should, being seen as mild addicts.

One study says this could result in 60 percent more people being classified as addicted to alcohol. A Stanford psychology professor who was a White House drug policy adviser believes up to 20 million people could be newly tagged as substance abusers.

All these new diagnoses will carry a price tag. The association argues they could get abusers into treatment earlier while critics fear they will only raise medical and insurance costs.

Although costlier, late-stage medical intervention for any affliction can be headed off by early treatment, we fear a different kind of financial consequence: a flood of new low-level diagnoses overwhelming the health care system and resulting in a shift of dollars away from patients who really need help.

Brent Robbins, an associate professor of psychology at Point State Park University, gave this sensible assessment to Post-Gazette reporter Anya Sostek for a story published Friday:

"Everyone who goes to frat parties at age 19 and drinks too much doesn't have an addiction. They are abusing the substance, clearly, but that's very different from someone who has an addiction. The difference between substance dependent and substance abuse is being lost, and that's not a good thing."

Other professionals agree, hence the controversy. If the psychiatric association wants its new manual to garner respect and have integrity, it should reconsider its proposed changes and weigh their far-reaching impact.


First Published May 21, 2012 12:00 AM


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