I am a Licensed Alcohol/Drug Counselor and a Licensed Independent Mental Health Practitioner in Nebraska. While I have not examined the Desk Reference thoroughly yet, here are some initial observations.
1. My copy is not missing any pages
2. Both the ICD-9 and ICD-10 codes are included in the DSM-5. The ICD-10 codes are in parenthesis. This is helpful and means we do not have to buy a new book when the use of ICD-10 becomes mandatory October 1, 2014.
3. I wish the DSM-5 Desk Reference was spiral bound as it will not take long before the binding breaks down due to frequent use.
4. DSM-5 does away with the multiple axis system which I find very helpful, particularly, the elimination of Axis 5 which was very subjective.
5. DSM-5 makes stressors that were previously identified on Axis 4 into diagnosis which are identified as "V" codes in ICD-9 and "Z" codes in ICD-10. I find this troubling. For example, Homelessness is now a mental health diagnosis V60.0 (Z59.0) OR, probably my current favorite, Problem Related to Current Military Deployment Status V62.21 (Z56.82). Given that I am a civilian counselor in the Army Substance Abuse Program and I am currently stationed in S. Korea, I will be using this code a lot. Are both of these problems stressful? YES. Can both of these lead to further chemical use or exacerbate or sometimes lead to actual mental health issues? You better believe it! But to make them diagnosis in their own right is a travesty. It is not going to lead insurance companies to pay for treatment for Homelessness or Problem Related to Current Military Deployment Status now or in the future. If I remember correctly, even Medicaid does not pay for treatment of "V" codes. This is part of the issue that Senator Rand Paul, MD is talking about with Obama Care although these were not the diagnosis he was talking about.
6. DSM-5 does away with the diagnosis of Abuse vs Dependence when talking about Substance use. This is helpful because many times professionals, who treat people with Substance use issues, will have a patient (client) who may meet two criteria for Substance Dependence and no Substance Abuse criteria will not be treated unless the clinician uses the Not Otherwise Specified diagnosis which I have not seen used very often. DSM-5 merges the Abuse and Dependence criteria and identifies it as Substance Use Disorder (replace the word "Substance" with the actual chemical or group of chemicals, thus Alcohol Use Disorder or Cannabis Use Disorder, etc.). There are specifiers (Mild, Moderate, and Sever) that relate to the number of criteria met when making the diagnosis. The diagnosis will not be given unless the patient (client) meets two criteria which is an improvement over the meeting a single criteria for Abuse in DSM-IV-TR.
7. DSM-5 has also changed some wording in the diagnosing of a Substance Use Disorder. The DSM-IV-TR diagnosis of either Substance Abuse or Dependence indicated a repeat of the problem which was difficult because it lead to premature diagnosis of a problem particularly in young adults and adolescents. Many people need to make a choice that leads to bad consequences more than twice before they recognize the problem. In other words, they had to learn that a particular behavior leads to a specific outcome by making the choice several times and experiencing the consequence several times. This is true of all learning no matter if the consequence is positive or negative. The DSM-5 rectifies this problem by saying, "A problematic pattern of ____ use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: . . .". This gives clinicians the ability to look for a pattern instead of just two incidences.
8. The one criteria that is still problematic is tolerance. The tolerance may take more than 12-months to occur as, for most people, there is no distinct easily identifiable change in a given 12 month period. Rather tolerance is a gradual thing so that significant change, particularly increase, does not occur within 12 months but over years. It would have been useful for the committee who worked on this section would have added a note to this criteria saying that the Tolerance criteria is met even if it took a number of years for significant tolerance to occur.
9. The addition of Cravings as a criteria for the diagnosis Substance Use Disorder is very helpful. As is the recognition that a patient (client) may still be in remission even if the patient (client) is having Cravings.
10. Changing the time when a patient (client) enters early remission from 1 month to 3 months seems realistic. Many patients (clients) can refrain from partaking of their chemical for a month or a little more but find they struggle with refraining from using for longer than that.
11. It would have been helpful if the page numbers for problems induced by a given substance, such as Alcohol-Induced Sleep Disorder, Cannabis-Induced Psychotic Disorder, or Hallucinogen-Induced Bipolar Disorder, etc., were identified instead of just being mentioned and the section Of the DSM-5 they can be found in.
12. I applaud the addition of Cannabis Withdrawal. Clinicians have been aware that patients (clients) experience withdrawal symptoms from Cannabis but it was not included in the criteria until the DSM-5.
13. There are changes in the way the DSM-5 groups some of the substances but this is relatively minor.
14. The overall heading of the section is Substance Related and Addictive Disorders thus Gambling Disorder is included in the same section. This actually is realistic to a certain extent but many clinicians who are trained to work with Substance Use Disorders are not trained to work with Gambling Disorders.
I know I mostly focused on the Substance Related and Addictive Disorders section of DSM-5 and I know that there are many concerns with the manual but I hoped this review helped at least a little. I am not giving it a 5 star rating due to the issues I noted above but there have been what I consider improvements in the manual particularly in the Substance Use area.
Deborah M. Ellison-Amburn, MA, LADC, LIMHP