What’s New in DSM- 5 For Clinicians Working with Mandated Populations

State Specialty Court Conference What’s New in DSM-5For Clinicians Working with Mandated Populations DuAne L. Young • The Change Companies®

Concept of Axes is gone… no Axis I to V • Personality Disorders remain but are no longer secondary (on par with Axis I) • GAF scores are no longer assigned General Overview of the DSM-5

Most common diagnoses have minimal changes regarding core symptoms • Some disorders are in new sections • Personality Disorders remain the same General Overview of the DSM-5

Bipolar Disorders is now in a separate section – the criteria are essentially the same • PTSD is now in a new section for Trauma and Stressor Related Disorders • Obsessive/Compulsive Disorder is in a new section with other compulsive disorders General Overview of the DSM-5

Allowing for Major Depressive Episode to be diagnosed while experiencing bereavement “Hot” topics

Disruptive Mood Deregulation Disorder – Essentially temper tantrums with persistent anger or irritability “Hot” topics

Asperger’s Disorder now encompassed in Autism Spectrum Disorders “Hot” topics

Dependence has a biological basis and is not just a more serious form of abuseDependence produces distinct and striking problem prevalenceDependence is a discrete syndrome of varying severity

Dependence may be substance specificThe prognosis for dependence is different than for abuse

SubstanceAbuse

Abuse may not have a biological component • Problem areas for abuse tend to be more limited than with dependence • Abuse is diagnostically distinct from dependence

Changes in diagnoses from dependence to abuse do not tend to occur – either continued dependence or recovery is more typical

Replace abuse &dependence with “mild substance use disorder,, “moderate substance use disorder” &“severe substance use disorder” • Combine 11 criteria into a single continuum of criteria Substance Use Disorders

Legal problems related to use are no longer part of the criteria… replaced with craving/compulsion to use • Early remission now 3 months • Craving only criterion that can be present in remission Substance Use Disorders

DSM-5 Alcohol Use Disorder • Substance taken in larger amounts over a longer period than intended. • Persistent desire to cut down or control usage. • Significant time spent obtaining, using & recovering from substance use. • Use resulting in failure to fulfill major role obligations.

DSM-5 Alcohol Use Disorder • Continued use despite recurrent social or interpersonal problems. • Social, occupational or recreational activities given up or reduced. • Use in situations that are physically hazardous. • Continued use despite known recurrent physical or psychological problems likely caused by use.

DSM-5 Alcohol Use Disorder • Tolerance: Use more to get the same effect and/or effects diminished with same amount. • Withdrawal symptoms (Criteria A & B for withdrawal). • Craving or strong desire or urge to use.

0–1 criteria = Nodiagnosis 2–3 criteria = Mildsubstance use disorder 4–5 criteria = Moderatesubstance use disorder 6+ criteria = Severesubstance use disorder Severity Scale

Continuum of use Mild Substance Use Disorder Moderate Substance Use Disorder Severe Substance Use Disorder No Diagnosis

Implications for our field • What does removal of legal criteria mean for assessment & placement of mandated clients? • How do the overall behavioral health changes impact placement? • How will the majority of our clients fall within the continuum of use?

Evince Clinical Assessments The Change Companies® • Brief assessments • Comprehensive & co-occurring * Placement & Planning * Workforce & SAP Evaluations * Outcome Evaluations

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What’s New in DSM- 5 For Clinicians Working with Mandated Populations