If you’re working in the mental healthcare profession, including addiction rehabilitation – or if you’re in recovery and treatment for addiction – chances are good that you’ve heard of the DSM-V (often referred to as the DSM-5).
The Diagnostic and Statistical Manual of Mental Disorders has been around since the 1950s, helping guide healthcare decision-making by doctors and other mental health professionals in North America and worldwide.
It’s not the only tool doctors use to help diagnose mental disorders like addictions, but it is a commonly used resource. And despite the criticism against it, and some of the challenges of using it in everyday practice, the DSM is a valuable tool healthcare professionals need to know about.
What is the DSM-V?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a handbook used by healthcare professionals to guide diagnosis of mental disorders. The DSM-5 (or DSM-V) is the latest edition of this handbook, published in 2013 by the American Psychiatric Association.
The DSM is constantly under review and revision by the Association as research and understanding of mental health increases and improves; further editions are expected if and when updates need to be made.
What makes the DSM so useful is its comprehensive catalogue of descriptions, symptoms, and other criteria for diagnosing mental disorders. It provides a common language for doctors to use when talking to each other, and to patients and their families, helping ensure consistent and reliable diagnoses as well as usable data for research.
Addiction in the latest DSM
The DSM is commonly used in addiction and rehabilitation to help diagnose and treat people’s addictions and other mental health issues.
Importantly, the DSM-5 defines addictions to alcohol and drugs as psychiatric disorders. By including addiction in the DSM as an aspect of mental health, the psychiatric profession has reinforced what we know from research and rehabilitation: that addiction is a brain disease.
The major change regarding addiction in the DSM-5 edition is that it combines together the categories of substance dependence (addiction marked by a pattern of compulsive use or loss of control) and substance abuse disorders (using in a manner that causes problems but does not have a pattern of compulsive use) under one broad category called “substance-related disorders”.
Substance-Related Disorders and the DSM
Specifically, the DSM-5 recognizes substance-related disorders resulting from the use of 10 separate classes of drugs:
Plus, the DSM-5 lists two distinct groups of substance-related disorders: substance use disorders and substance-induced disorders. Both groups are important in the diagnosis, treatment, and research of drug and alcohol use and addiction.
Challenges to Using the DSM
The DSM is not the only reference out there to diagnose addiction or any other mental health condition. The World Health Organization publishes the International Classification of Disease, which is often used side-by-side with the DSM as a compatible tool for diagnosis and monitoring.
Some, like the National Institutes of Health, have criticized the DSM for focusing too much on superficial symptoms and a lack of measurable, scientific signs of mental health disorders. Others, like Alcoholics Anonymous, prefer to use models outside such clinical classification systems.
However, here at Renascent we recognize that the DSM does contain the most up-to-date criteria currently used for diagnosing mental disorders like addiction, and that despite its challenges, it is routinely and widely used.
So many of us seek recovery when we are desperate and have tried our own ways and failed. We have had our share of pain and suffering and are looking for the solution. Yet the biggest riddle is this: When given the solution, many of are unwilling to fully accept it or do what we are told will make us better. Many of us want recovery on our own terms. “I’ll do this, but not that.”
I was one of those people. Initially, I never even wanted to be a sober person. Sobriety to me was the end of the road and signified the end of my life. Unknowingly, I sabotaged my every attempt to be sober. It took me six years of constant relapsing to become completely 100% willing to go to any lengths.
When I first entered AA, the initial problem I had was with God. I didn’t believe nor did I plan to. My mind was a steel trap. Completely closed. This was the first sign of my unwillingness. Straight out of the gate, I wanted it my way. I relapsed.
My next attempt at recovery was doomed because of my dislike of the 12 steps. I was aghast at the notion of being told that I might have some character defects or was less than perfect. How dare AA suggest that, without knowing me! No AA for me and I continued to relapse. I chose a different path of recovery, known as harm reduction. No 12 steps, no need for God. This I would do. I entered a harm reduction treatment centre and relapsed five days after leaving.
My options were running out and my relapses were getting worse. I didn’t yet understand that my alcoholism was progressing. My work was being affected, my family was at their wits’ end, and I was isolating and binge drinking. I decided I would give AA another try and imagined I would be finally healed. I went to some meetings and sat in the back row (relapse row). I never went early and I shot out of there as soon as the Lord’s Prayer was recited. I continued to relapse.
I decided to get a sponsor but was unwilling to calI her because I was full of fear, I had social anxiety, and a phone phobia. In my mind, I was going to AA, I was accepting God, and I had a sponsor and believed this was enough. Now when I relapsed though, my short spurts of binge drinking had progressed to not being able to stop once I took that first drink. The nightmare of a binge would not end until I went to the hospital.
I decided I was not connecting to my sponsor so I got a new one and she made me begin the steps. I started to get better and got a little bit of sobriety time. I didn’t really enjoy AA though. I didn’t connect to the fellowship. I still had some of my old friends and still wanted my old life. I was one foot in and unwilling to jump in with both feet. And although my relapses were farther apart, they had become dangerous, terrifying, and worst of all, life threatening. I was locked up in the psych ward on a Form 1 more than once, in and out of the hospital, suicide attempts, injuries, and loss of my driver’s licence. My body and my mind were no longer working properly. I was a shell of my former self.
I was beaten. I knew this disease was going to kill me so I put myself into Renascent. There began a journey of real recovery and the beginning of a new life. I became willing. I decided I would do anything and everything I was told to do. I did the work. After leaving Renascent I did their Continuing Care program, I did 90 meetings in 90 days, I did the 12 steps, and I got active in the program and in service. I went to retreats, round ups, conferences. I went to closed discussion meetings and Big Book studies. When I was afraid or unwilling, I prayed for help for strength and willingness. I built a foundation of trust in my Higher Power and began to think of myself as a student of AA and recovery. The more I did, the more I began to like it, and even love it. I learned tools to live happily in this world without the need or desire for any substance.
This past February I celebrated two years of sobriety.
I am continuing to learn and grow and I feel grateful every day. I look back at my stumbling blocks and I remember thinking that because I couldn’t understand how or why things worked, that they couldn’t possibly. I remember thinking “How will praying help me find a job and pay my bills?” “How will going to a meeting affect my day today?” I had been unwilling to listen and trust. In the end, I just had to do the things I was told to do.
At a 12-step retreat I attended a little over a year ago, I read something that has stuck with me, because it described the old me. It read, “Most people say to God, ‘Prove to me that you exist and I will believe in you.’ God says in return, ‘Believe in me, and I will prove to you I exist.’” For me, that says it all. Believe first. Do the work. Live a life beyond your greatest dreams.
Last year I went to India for two months to study yoga and meditation. This year I am travelling to Thailand for a month to volunteer for an organization that rescues street dogs. This is a life I never could have imagined. I have had a spiritual awakening and the desire to drink has been lifted from me. I have a love for recovery, for AA, and for 12-step living. I am no longer running the show; thank God for that!
Officially I don’t belong to a 12-step group; I do have a sponsor who has become like a sister, and a team of incredible women who inspire, mentor, entertain, challenge, and have continued to love me on my best and worst days over the last 8 years, 10 months. Some may say that because I don’t have a home group, I am not a member of AA. I remind them the only requirement of membership is a desire to stop drinking.
For the past 8+ years, I have lived my best life. I am the same woman who could not stop drinking for anything or anyone; I was hopeless and destined to die until I finally “surrendered” in January 2010.
I am growing up in AA and was actively involved in service for a number of years. I still say I owe everything to AA, my higher power, and the people who showed me the way. This includes people outside of 12 step and the people who stick around the rooms, make coffee, and open the doors. I have experienced my parent’s funeral and my child’s wedding, and I didn’t drink — this is truly a miracle. I have found a recovery program that worked for me, and I have persevered. I still consider myself in early recovery, and I don’t hide my recovery from the public. Whenever I can put a face to recovery, I do it with pride as a person with lived experience of a substance use disorder and long-term recovery.
What I’ve learned along the way is there are many roads to recovery, and recovery looks different for everyone. What I measure as success may not be what you consider success. One of the very first teachings in AA was “to keep an open mind” and when I was in early sobriety, I was very opinionated about the quality of other people’s programs even though the next thing I was taught was “live and let live.” It took time, patience, pain, and practice to stop looking at the quality of other people’s lives and focus on my own.
What prompted me to write this is that I want to — as a member of Alcoholics Anonymous — provide an alternate perspective when it comes to harm reduction, abstinence, cannabis, methadone, suboxone, and other mood-altering substances. What people choose to do is none of my business; I want my friends and members of the fellowship to live their best lives. I don’t care if you smoke pot, I don’t care if you drink, I don’t care if you come to meetings drunk. I care that you’re happy, I care that you’re whole, I care that you’re not suffering, and I care that you’re alive.
Letting go has been a process, and for me that means freedom.
Sadly, children are often the first hurt by alcohol and drug addiction and the last helped. Children of alcoholics are four to nine times more likely to develop an addiction as a direct result of their family experience. Left untreated, these kids are more likely to suffer from depression and other mental health issues as teenagers and adults.