Should the DSM-IV or DSM-5 list abused substances?
There are a number of substances that come naturally to mind when one thinks about substance abuse or addiction. Bath Salts, Super Glue, the propellant from canned whipped cream, and prescription drugs are all examples of substances that a person could abuse or become addicted to. Individuals engaging in this type of behavior may have a difficult time distinguishing between a “good” drug such as penicillin, and a “harmful” drug such as alcohol. Because of this, many times when professionals attempt to assist someone with a drug-taking behavior, they are faced with an uphill battle regarding perception.
History has also shown us that over time, various types of substances have gone through periods of acceptance versus non-acceptance based upon community standards. Even the way that a substance is being consumed has influenced society’s opinion regarding the level of acceptability of a drug. Opium as a drug could be utilized in a variety of ways, including drinking a liquid form and smoking the substance. “The respectable way was to drink it, usually in a liquid form called laudanum. By contrast, the smoking of opium, as introduced by Chinese immigrants imported for manual labor in the American West, was considered degrading and immoral (Levinthal, 11). Over time, American society came to see that opium was a very dangerous drug, regardless of how it was consumed.
I believe that the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual (DSM) accurately does not list any specific substances in order to guide professionals treating substance abuse. By not listing specific substances, the actual substance becomes irrelevant. “The position of the American Psychiatric Association is that a judgment of whether a person has a problem of dependence or abuse should depend on the behavior of that person, not on the chemical that is being consumed” (Levinthal, 42).
By not listing specific substances, the APA accomplishes a number of things. First, the temptation to argue over whether or not a substance is “bad” for an individual is removed. A professional does not have to waste valuable time convincing someone that canned whipped cream is a bad thing. The substance is irrelevant in the clinical setting, only the behavior of the person in treatment does. Second, the APA does not have to worry about the changing of societal norms. The use of many drugs including opium and cocaine have been accepted by society in the past. However, as doctors learned more about the dangers of these substances, the acceptability of them has waned. By not listing substances at all, the DSM becomes a more timeless resource that does not need to be updated to include nor exclude specific substances based on sometimes arbitrary attitudes.
In using this approach, the professional can focus on treating behaviors and utilize the increase or mitigation of the destructive fallout of the behavior as a way to mark progress in the person being treated. It’s really hard to convince someone to stop doing something that feels really good unless you can show them how the behaviors they are exhibiting while feeling good are worse for them than the feeling the substance induces.
Levinthal, C. F. (2012). Drugs, behavior, and modern society. (6th ed.). Boston: Pearson College Div.