Substance Abuse Disorder & The DSM-5

The Diagnostic and Statistical Manual of Mental Disorders is a classification of mental disorders published by the American Psychiatric Association. Initially, it was developed with a single aim to collect statistical data about mental disorders in America. It uses various criteria to create more reliable diagnoses and aid in the treatment of illnesses. The first edition of the DSM was published in 1952, while the attempts to collect information on the disorders began in 1840. For more than 60 years, successive editions of DSM have been used in the field of mental health. Moreover, medical personnel use it as a primary tool for diagnosing patients, while students use it as an educational resource. Medical field researchers, in their turn, use it as a reference to their studies. Mental health professionals such as psychiatrists, psychologists, social workers, rehabilitation therapists, nurses, and others consider this classification of a tremendous value. This research paper discusses the symptoms of substance use disorder according to DSM-5, differences between DSM-IV and DSM-5, diagnosis of a person according to case information, and treatment recommendations. It also reviews the current demographics relating to the abuse of prescription medication and factors that contribute to these trends, and provides readers with suggestions on how to prevent addiction to prescription drugs.

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Symptoms of Substance Use Disorder

In May 2013, the American Psychiatric Association issued the latest fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-5. Like all the previous editions, it is concerned with classification of mental disorders. It continues the work and the aim of its predecessors and provides guidelines for diagnoses, treatment, and management decisions. One of disorders that DSM-5 describes is substance use disorder, which is classified into three categories: with mild, moderate, and severe. According to the newest edition, a substance use disorder is the usage of alcohol or other substances that cause stress and adverse effects on the daily lives of people. The DSM-5 lists various substances that may cause addiction in a person. For example, alcohol, tobacco, cannabis, inhalants, hallucinogens, phencyclidine or opioid. Besides, a person can develop addiction to sedatives and hypnotics as well as anxiolytics, stimulants, amphetamine, and cocaine.

According to the DSM-5, a person can be diagnosed with a substance use disorder if he/she displays two of the following 11 symptoms within one year. The first symptom is consumption of a greater amount of a particular substance or alcohol than initially planned. Second, a persons worries or failures to control the substance use can indicate a disorder. The third symptom refers to spending much time taking alcohol or drugs or using all means to obtain it. Next, the substance usage affects a persons obligations, including work, education, and home. Additionally, if a person craves the substance, it may also be an indication of a problem. The other symptoms may refer to the continuation of using substances despite the adverse effects on health or even relationships with people. Continuous usage of alcohol or drugs in dangerous situations, such as car driving or machinery operating, may also be a determinant of a disorder. The next symptom of substance abuse is avoidance of personal life activities. Moreover, the formation of tolerance or habituation to the substance may indicate a disease. Finally, yet importantly, if a person experiences withdrawal symptoms including anxiety, fatigue, and nausea after stopping the substance intake, he/she may be diagnosed with the disorder.

Differences Between DSM-IV and DSM-5

Even though the new DSM-5 edition considerably overlaps with the prior DSM-IV, several differences need to be identified. First, there are changes in disorder terminology. For instance, DSM-IV discusses substance abuse and substance dependence as two different disorders with specific criteria for each. DSM-5, in its turn, integrates them into a single substance use disorder, also known as SUD with mild, moderate, and severe criteria. The second and the most substantial difference between these two editions refers to the diagnosis of the disorder. According to DSM-IV, if a person met one or more criteria for substance abuse within a year, he/she would receive a diagnosis of this type of disorder. If a person received three or more criteria for substance dependence within the same period, he/she would receive a diagnosis of dependence. According to DSM-5, if a person meets at least two out of eleven criteria during a year, he/she would be diagnosed for SUD. The severity of a substance use disorder depends on the number of criteria met. For example, the presence of 2-3 symptoms indicated a mild severity of SUD, 4-5 symptoms are considered as moderate, and 6 or more as severe.

Diagnosis of Fran

Having thoroughly examined Frans case and considered the diagnostic criteria, I have diagnosed that she has a severe substance abuse disorder based on DSM-5. First, Fran started consuming higher doses of prescription drugs than originally planned. The main reason is that the initially prescribed doses no longer gave her the sensation of relaxation and calmness. Second, Fran twice failed in her efforts to stop using prescription drugs. The first and the second time she managed to spend only several days without painkillers. Both times, she had adverse effects on her overall health after stopping using medicine. Third, she started doing whatever it takes to obtain the desired medicine. For instance, Fran started submitting fake prescriptions to the pharmacies. The next symptom that proves that Fran has substance abuse is the failure of fulfilling her daily obligations. She started coming late to work and missing deadlines of projects. Moreover, her husband proved that their relationships worsened, because she started behaving differently with detachment and irritation.

Another diagnostic criterion that Fran meets is the usage of drugs despite their negative effects on relationships with her husband and employer. Additionally, Fran started reducing her personal and professional activities due to substance usage. She neglected not only her work but her family as well. The next symptom that Fran displays is the formation of tolerance to the prescription drug use. After understanding that the doses prescribed by the doctor do not give her positive feelings, she tried to take larger doses. Finally, Fran experienced withdrawal symptoms after stopping prescription drug use. She started feeling anxious, irritable, and not herself when she stopped taking them for the first time. The second time she experienced headaches, anxiety, and blurred vision. Overall, the presence of six or more symptoms indicates the severe level of substance abuse disorder. Fran, in her turn, had eight out of eleven symptoms listed in the DSM-5 classification.

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Treatment Recommendations

Based on the case information presented and the diagnosis made, Fran requires immediate treatment of the severe substance abuse disorder. Even if Fran decides to avoid treatment or offers self-treatment, legal interventions and the pressure of her family members may help her enter the treatment and complete it successfully. First, Fran should start participating in behavioral therapies. Professional therapists will help her strengthen her motivation to change. Behavioral therapies will help her resist substances and replace them with healthy activities and relationships. Second, Fran should be checked for the other mental health disorders that abuse could cause. Overall, the patient should be regularly monitored for substance abuse. After the end of her treatment program, Fran requires rehabilitation that will assist her in avoiding potential relapses.

Current Demographics and Trends in the Abuse of Prescription Medication

The majority of people in the contemporary world at least once have had an experience of obtaining a prescription drug. This process is usually very simple. At first, a person should visit a doctor and describe the medical issue he/she is facing. After that, a doctor establishes diagnosis and prescribes medicine that should eliminate the patients problem. In 2013, more than ten million prescriptions were filled in American pharmacies every day. However, an enormous number of these people started using prescription drugs for the purposes different from those for which the medication is intended. Usually, they use it to get intoxicated or drugged. This practice is illegal and causes adverse consequences to peoples health. According to Dr. Nora D. Volkow, the director of the National Institute on Drug Abuse, nearly 52 million people used prescription drugs for non-medical purposes at least once in a lifetime. Shockingly enough, 20% of them were Americans over the age of twelve. This figure makes people consider prescription drug abuse as a widespread issue in the United States of America.

Americans are using prescription medication for non-medical purposes more often than they are using cocaine, hallucinogens, heroin, and inhalants combined. The data for prescription drug abuse may vary with age, gender, ethnicity, and many other characteristics. Women, youngsters, and older adults are at greater risk for developing prescription drug addiction. Unlike men, women experience emotional conditions and chronic pain more often, which leads to an increased risk for medication abuse. In comparison to youth, elderly people take more medication. Their weakened bodies cannot fully metabolize the medicine, and therefore create a diminished effect. Thus, they increase the doses of their prescription drugs and place themselves at a greater risk for abuse. Additionally, the differences in abuse also occur among different ethnic groups. For instance, prescription drug abuse most commonly occurs among American Indian population and comprises nearly 5%. The second group is the Caucasians, whose addiction accounts for approximately 3%. Finally, this type of abuse is least common among Asians and comprises only 1.2%.

Prescription drug abuse among young people has always been the center of attention. For nearly nine years, from 1991 to 2010, prescriptions for stimulants have increased by seven times from 4 to 45 million. The demand for opioid has increased three times from 76 to 210 million. However, the increase occurred primarily among the young population from 12 to 25 years of age. The main reason for such situation throughout the country is the easy access to prescription medications. They can get it not only from doctors but friends and family members as well. Teenagers can get a prescription for everything, including insomnia, hyperactivity disorder, anxiety, etc.

Contributing Factors to the Trends and Demographics

Today, it is impossible to understand reasons and contributing factors to the significant rise in abuse rates. Some people believe that the causes of addiction are increased supply, rising street values, and peoples belief in the safety of prescription medications. Initially, the demand plays the biggest role in peoples ability to get the required drug. The more medications are prescribed, the higher is their availability. Second, the street cost for prescription drugs is several times higher than the pharmacy one. Due to the large profit, drug dealers will do anything to get prescription drugs and to sell them on streets. Finally, the public considers prescription drugs safer than illicit ones. The majority of people trust doctors and think if they prescribed it, then it is safe to use. However, they should always remember that the slightest deviance in use may result in addiction and adverse health consequences.

Addiction Prevention

One of the major tasks of the patient care is to prevent a patient from becoming addicted to prescription drugs. However, it is important to remember that the doctor should not avoid prescribing any medication if required. The first thing every physician should do to prevent prescription drug abuse is to explain patients the correct amount of drugs they should take without getting addicted to it. At the same time, they should explain their patients the potential threats of overdosing. Second, the doctor should periodically check on patients and be ready to identify abuse. Third, when noticing that a patient started taking more medication than needed or requesting for unscheduled refills, every physician should start immediate treatment. Health care providers are responsible not only for the patients treatment from a certain condition but also from the addiction that medication has caused.


Drugs and alcohol have an adverse effect on peoples bodies. Thus, all patients having a substance use disorder require a thorough medical examination. DSM-5 criteria for a substance use disorder provide patients with a list of symptoms that assist physicians in diagnosing addiction. Moreover, the immediate diagnosis of the disorder makes it easier to treat it. The examination of the current demographics in the abuse of prescription medication and factors that contribute to these trends may help doctors, family members, and individuals prevent the addiction.