DSM-5 awry?

A. Frances article

postscript:

Can I offer an alternative perspective?

1. Public health requires us to avoid stigmatizing terms. Many people will not walk into a public health facility called “Addiction Services” or “Drug Abuse Services” unless a judge tells them they must do so to avoid a criminal penalty. Why use a term with stigma laden history? We can do better than that.

2. Elimination of the legal problems criterion is a step forward that helps us stabilize estimates across different policy regimes. A good step.

3. But retention of the socially maladaptive criteria fails to remove variation due to individual or socially shared responses. If your mother is of Islam, your alcohol  use will prompt a family problem. If Ethical Culture Society member, not so much. The distinction between the axis of social maladaptation deserves to be studied separately, and not made a defining criterion for our case definition.

4. Case definition can be framed as (a) presence of a disturbance of the mental life (such as obsession-like craving or rumination), (b) disturbance of behavior (such as compulsion-like repetitive use when such use is not wholly controlled by the user, and inserts itself into the behavioral repertoire even though the plan did not include that behavior), and (c) signs of neuroadaptive changes secondary to repetitive drug use (such as subjectively felt or lab-confirmed tolerance, or withdrawal signs or symptoms).

5. The term is “drug.” The term “substance is not a scientific term. It is a political term, introduced in the early 1979s when the US government had ambivalence about calling alcohol a drug. Use the term substance when you feel a need to be politically corr t, but in science, these all are drugs.

6. In American usage ‘illicit’ carries a moral overtone, as in an ‘illicit affair between Trump and Stormy Daniels’ — i.e., inherently pejorative Nd stigma-laden. Why use that adjective unless you wish to heap stigma upon users?

7. Is adult cannabis use ‘illegal’or ‘illicit’? Not in parts of the world like Portugal or Colorado or Washington State or California, etc. It is an “internationally regulated drug (IRD) under the psychotropic drug conventions, but it is neither illicit nor illegal in many parts of the world.

Choose your case definitions and terms wisely, and in a manner that promotes the public health goals you seek to achieve.

If you want to encourage people to seek treatment, don’t use stigma-lad n terms in your science and public health reports or work.

My two cents.