Charles O'Brien, M.D., Ph.D.
The work group has been systematically addressing areas of DSM-IV that have been the focus of concern and debate. Great progress was achieved at the September face-to-face meeting at APA and continues to be made in bi-weekly conference calls. Several sub-work groups have been formed and are having separate conference calls of their own.
Some of the issues being considered are:
Should the concepts of “Addiction” and “Addictive Disorders” be used in DSM-5? What are the advantages and disadvantages of using such terms?
Are the “Substance Use Disorders” and the so-called “Non-substance Addictions,” such as pathological gambling related, and if so, what are the nature and strength of the relationships? Among the other widely suggested candidates for a possible “Non-substance addictions,” category (e.g., internet gaming, eating, shopping, sexual activity), how strong is their research evidence base?
The problems of the substance abuse category have been pointed out in many studies and reviews, for example, its factor structure related to substance dependence, and the cross-cultural generalizability of several of its symptoms. The work group is studying alternative ways to address the problems with this diagnosis, and develop a more cohesive structure for substance use disorders. Several data analyses are being conducted to help in this endeavor.
In terms of diagnostic criteria, drug craving is being considered as a possible additional criterion. Consideration is also being given to some drug-specific criteria to improve clinical and research utility. Proposed criteria for cannabis withdrawal are being examined.