“My plan was to have my new daughter, breastfeed her to health, and then do all of those I loved a favour, and, well, check out early so to speak. Luckily, my daughter was born healthy and as I kept my promise of keeping her fed, I would begin to sketch while I was up at night. These sketches were as raw as those receptors reawakening in my brain…
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 begins “The Road Less Travelled,” a wisdom book about living well by Scott Peck. Talk about keeping it simple! We hear the same awareness time and again in the rooms of recovery: “Just because I’m sober doesn’t mean my life is easy.”
I had no idea what Peck was talking about when I first opened his book back in the mid-1980s — probably because I was neck deep in my addiction and desperate to believe that everything in my life would just work out. Magically.
Now I get it — probably because I’ve been clean and sober for a while and I’m paying attention. Today I’m free to say “Yes” to life, and most days I choose to face life on its terms, not mine, as best I can.
Unfortunately for me, however, I don’t always have answers for life’s challenges. The next right action isn’t always clear to me. In fact, living sober sometimes leaves me feeling as rudderless, scared, and discouraged as I felt when I was using.
Life is difficult. And I don’t mind admitting I need a power other than King “I” to help me live sober — just as I needed that same power to help me get sober.
Enter Step Eleven, my favourite Step.
Something about this Step grabbed me — I can’t quite say what. I jumped right into it the day after l graduated from “The House.” I still try my best to greet each new day with a time of prayerful and meditative quiet.
At first this was new and it was hard. And I definitely still need discipline to keep it up. I do keep it up because I’ve grown to like how the still, deep quiet feeds my spirit. I need that. And I love the results.
Step Eleven is my anchor. Working this Step keeps me grounded in my relationship with the higher power I committed to in Step Three, and then some — it takes that relationship to a deeper place. I tap into courage when scared; strength when worn out; comfort when hurt or lonely; determination when discouraged. Step Eleven keeps me trudging along.
Over time, I’ve learned what works best for me. If I want solid results, I need a solid morning routine with built-in quality time for practicing the Step. A rush job doesn’t cut it. For me, that’s 20 minutes minimum — I prefer at least a half hour, if not longer. And of course that dictates when I set the alarm!
I’m better at the conscious part of “conscious contact” if I start by taking what time I need to calm my thoughts, relax my body, and settle into a true quiet. Sometimes that takes a few minutes and sometimes, on bad days, longer. And I’m more open — less easily distracted — if I do my Step work first thing in the morning, before the rush of getting ready for work.
Step Eleven is also my rudder. I can’t describe how that works for me any better than the Step itself does:
“In thinking about our day we may face indecision. We may not be able to determine which course to take. Here we ask God for inspiration, an intuitive thought or a decision. We relax and take it easy. We don’t struggle. We are often surprised how the right answers come …”
~ “The Big Book,” Step 11, page 86
“Ask.” I don’t always know what to do. When I was new and inexperienced with this Step I’d pray for direction, then immediately look to the elders in recovery for advice. I still do.
“Relax and take it easy.” “Don’t struggle.” If I’m anxious and impatient, then I’m fighting the Step. That blocks the power in the process from doing its work.
And then, “Surprise!” A burden lifted; a door opened; a next step; a new direction.
Practicing this Step over time has given me a more open heart, one with a greater capacity to listen. It’s more natural for me to sit and wait with patience. Best of all, I can better recognize the inspiration, or intuition, that actually does come from my deepest, truest self, from my wise child, from my God. And to trust it!
All in all, Step Eleven gives me an unshakeable foundation for life — just as it promised me.
Practicing this Step over time has given me a more open heart, one with a greater capacity to listen. Best of all, I can better recognize the inspiration, or intuition, that actually does come from my deepest, truest self, from my wise child, from my God.