Past Issues

The DSM-5 Changes and Challenges in Diagnosing Substance-related Disorders

Chang-Chih Tsou, San-Yuan Huang

The DSM-5 that was released in May 2013, has incorporated scientifi c advances,
and enhanced clinical utility with more concise, as well as been amenable
in primary care. In this overview, the authors review the new classifi cation structure
and changes in diagnosing substance related disorders from the DSM-IV to the
DSM-5, and point out the new challenge with the new criteria. The major changes
of the DSM-5 include (A) renaming the title of chapter; (B) substance reclassifi cation;
(C) eliminating the terms of dependence and abuse, and merge the criteria of
substance dependence and abuse together; (D) removing legal problem and adding
craving in substance use disorder criteria; (E) course specifi er modifi cation; (F)
modifying substance-specifi c disorders, such as separate substance-induced mood
disorder into bipolar and depressive disorder, and separating substance-induced
obsessive-compulsive disorders from anxiety disorders; (G) newly adding or removing
each class diagnosis of substance related disorders; (H) adding non-substance-
related disorders; and (I) adding other substance-related and addictive disorder
for further study. Although the DSM-5 solves the problems of the DSM-IV,
there are several challenges in diagnosing substance-related and addictive disorder:
First, what behaviors could be considered as an addiction is still an ongoing
debate. Second, there are some controversies on the new criterion “craving.” Third,
the polysubstance is still an important issue to be discussed. In addition, this overview
also covers the changes from the ICD-9-CM to the ICD-10-CM codes related
to the substance-related disorder of the DSM-5, but present some discrepancies
between the DSM-5 and the ICD-10-CM for more clinical conveniences and
Key Word substance related and addictive disorders, neurobiological advances, DSM-5, ICD-10-CM
Editorial Committe, Taiwanese Journal of Psychiatry
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