Why Not Use the DSM-IVR for Diagnosing Addiction?

1. Why Not Use the DSM-IVR for Diagnosing Addiction? Reason #147: Inadequacies of using qualitative indices for a quantitative problem

2. DSM-IV Classification of Addiction • DSM does not use the term addiction • Same concept is described under substance dependence disorder

3. DSM-IV Criteria • A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following, occurring at any time in the same 12-month period: • Substance is often taken in larger amounts or over longer period than intended • Persistent desire or unsuccessful efforts to cut down or control substance use • A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), using the substance (e.g., chain smoking), or recovering from its effects • Important social, occupational, or recreational activities given up or reduced because of substance abuse

4. DSM-IV Criteria, continued • Continued substance use despite knowledge of having a persistent or recurrent psychological, or physical problem that is caused or exacerbated by use of the substance • Tolerance, as defined by either: • (a) need for increasing amounts of the substance in order to achieve intoxication or desired effect; or • (b) markedly diminished effect with continued use of the same amount • Withdrawal, as manifested by either: • (a) characteristic withdrawal syndrome for the substance; or • (b) the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms

5. Is Sasha Addictive? • You have to meet her to understand.

6. Meet Sasha

7. DSM-IV Criteria Met • Substance is often taken in larger amounts or over longer period than intended • She takes a lot more time than originally anticipated

8. DSM-IV Criteria Met • Substance is often taken in larger amounts or over longer period than intended • Persistent desire or unsuccessful efforts to cut down or control substance use • She successfully resists attempts to decrease her high maintenance and become more self-sufficient (e.g., play by herself, eat dog food)

9. DSM-IV Criteria Met • Substance is often taken in larger amounts or over longer period than intended • Persistent desire or unsuccessful efforts to cut down or control substance use • A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), using the substance (e.g., chain smoking), or recovering from its effects • Very high maintenance, e.g., trips to the vet, trips to Pet store, food preparation, poop-n-scope, maintaining her rolling dog house

10. DSM-IV Criteria Met • Substance is often taken in larger amounts or over longer period than intended • Persistent desire or unsuccessful efforts to cut down or control substance use • A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), using the substance (e.g., chain smoking), or recovering from its effects • Important social, occupational, or recreational activities given up or reduced because of substance abuse • Radical change in life style

11. Four DSM-IV Criteria Met • Substance is often taken in larger amounts or over longer period than intended • Persistent desire or unsuccessful efforts to cut down or control substance use • A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), using the substance (e.g., chain smoking), or recovering from its effects • Important social, occupational, or recreational activities given up or reduced because of substance abuse

12. Might as well admit it you’re addicted to love. —Robert Palmer

13. So Is Sasha Addictive? • Probably not • problem with “where to draw the line” (i.e, applying qualitative criteria to a quantitative problem) • even if the behavior is viewed as additive, it represents an interaction (Sasha [Cavalier King Charles Spaniel] x personality traits [prof.]) and not an attribute of Sasha • perhaps self-medication? • no justification to regulate availability of “Sashas”

14. But She’s Still Cute Sasha rules!