The Diagnostic and Statistical Manual, or DSM, is the gold standard for mental disorder diagnosis and treatment in the United States. The DSM provides the last word on what is and what is not a mental disorder. The manual also determines whether or not a person qualifies for treatment, be the condition autism, depression, alcoholism or any other mental disorder.
The American Psychiatric Association is close to releasing a new edition of the DSM, the first update in fifteen years. The new DSM offers a different way of categorizing drinking problems, which could help people receive early treatment and alcohol abuse counseling.
Traditional Alcoholism Diagnosis
Under the old DSM criteria, drinking problems fell into two categories: alcoholism and alcohol abuse. The DSM essentially divided drinkers into two neat little categories: those who had a drinking problem and those who didn’t. This may lead to some dangerous thinking.
People could, of course, abuse alcohol without meeting the DSM criteria. Alcoholism and alcohol abuse don’t suddenly appear: they develop over time. A person could be at risk of “full-blown” alcoholism, but not receive help because she didn’t meet DSM criteria for the disease. Alcohol abusers could also deny they had a problem because their drinking habits and symptoms didn’t match diagnostic criteria.
The Drinking Spectrum
We now understand alcohol consumption can cause physical and mental complications without meeting the old DSM’s rigid requirements. The proposed DSM recommendations remove the dividing line between alcohol disorders and “normal” drinking, replacing the old criteria with the drinking spectrum, a sliding scale between normal and disordered drinking.
At one end of the scale are those who drink in accordance with the National Institute on Alcohol Abuse and Alcoholism guidelines. The NIAAA recommends no more than one drink a day and a limit of seven a week for women and no more than four drinks a day or fourteen a week for men.
At the opposite end of the spectrum are people who meet the traditional criteria for alcohol abuse and alcoholism. Alcohol use in such cases has a universally negative effect on physical health, emotional well being, social life, relationships and work.
In between these two extremes lies a gray zone, occupied by people who drink more than the NIAAA recommends, but who don’t meet the criteria for alcoholism or alcohol abuse. Some of these people have no need of treatment, while others stray dangerously close to alcohol abuse, and could benefit from early alcohol intervention programs.
Changing Attitudes with the Drinking Spectrum
Instead of seeing alcoholism and alcohol abuse as “all or nothing” disorders, the new edition of the DSM recognizes drinking problems develop by degrees. The new drinking spectrum encourages people to seek treatment and counseling before developing full-blown alcohol disorders.
Posted on February 5th, 2013 in Help Blog