Chemical Dependence, as defined in the DSM, considers a number of factors, including the presence of abuse over time, as well as physiologic factors
Although dependence is often associated with addiction, it can be the body’s normal response to a substance. Previously, drug or alcohol dependence was a separate diagnosis, which caused a lot of confusion for both patients and doctors.
Today, the diagnosis of substance abuse disorder categorizes substance abuse and substance dependence into a single disorder, which has a rating from mild to severe. Mild substance use disorder in DSM-5 requires two to three symptoms out of 11 listed. So it’s harder to be diagnosed with this disorder than previously.
Change From DSM-IV
Previously, the distinction between abuse and dependence was based on the concept of abuse as a
mild or early phase and dependence as the more severe manifestation. In practice, the abuse criteria
were sometimes quite severe. The revised substance use disorder, a single diagnosis, will better match
the symptoms that patients experience.
DSM-IV criteria for substance dependence included whether substance dependence coincided with or without physiologic dependence (tolerance or withdrawal).
In addition, remission categories are classified into four subtypes:
- early partial
- sustained partial
Remission is based on the designation for abuse or dependence, and may also be used if a patient is receiving agonist therapy, like methadone maintenance to help with withdrawal. It may also be used for people who have just completed a drug rehab program and are now living in a drug-free environment, such as a sober living home, or aftercare facility.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Washington, DC: American Psychiatric Association, 2015. Substance related and addictive disorders
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