Here’s an example of one person’s presentation with a substance use disorder:
Ron is 37 years old and was referred to you by the court system following a recent DUI conviction. He says he was at a friend’s birthday party and thought he could safely drive home after drinking “a few” beers. He’s really upset about the DUI and feels a lot of embarrassment. He’s worried about the financial expense and loss of his license for a year. He’s had a hard time sleeping because of the worry and depressed reaction he’s experienced since the DUI.
Upon further investigation, you find that Ron drinks “several” beers most nights of the week. He estimates that he drinks 6-8 beers a day, “sometimes more, sometimes less.” He has tried to cut back, but has been unsuccessful in those efforts. He used to “feel a buzz” after drinking 3-4 beers, but now it takes 6-8 to get the same feeling.
He smokes pot with his work friends, but doesn’t like to do that regularly because of his fear of failing a random drug test at work. He smokes pot 3-4 times monthly. When he tries to cut back, he finds himself feeling strong urges to smoke pot.
He is a cigarette smoker, smoking about a pack a day.
If you were going to diagnose Ron, it might look something like this:
309.0 Adjustment disorder with mixed anxiety and depressed mood
305.00 Alcohol use disorder, mild
305.20 Cannibas use disorder, mild
305.1 Tobacco use disorder, mild
More to Think About
I do want to emphasize that not all of the changes in the new manual are causing angst and woe among clinicians. I’ve highlighted the top three modifications that people are finding frustrating.
There are some changes that people are feeling good about. They seem to like the severity scales being specifically tailored to many different diagnoses. For example, anorexia severity is determined by a person’s BMI (body mass index). Bulimia severity is based on the number of inappropriate compensatory behaviors weekly (vomiting, laxative use, over-exercising, and so forth). Oppositional defiant disorder severity is based on the number of settings in which symptoms are present.