DSM 5 Could Mean 40% of College Students Are Alcoholics

[jimmy olsen]

If an accurate description of the situation this is ridiculous. 

http://healthland.time.com/2012/05/14/dsm-5-could-mean-40-of-college-students-are-alcoholics/?iid=obnetwork#ixzz1vBGb1cjS

DSM 5 Could Mean 40% of College Students Are Alcoholics
Most college binge drinkers and drug users don't develop lifelong problems. But new mental-health guidelines will label too many of them addicts and alcoholics.

By Maia Szalavitz | @maiasz | May 14, 2012 | 37

Are you or have you ever been a college binge drinker? Welcome to alcoholism, a diagnosis your college self could qualify for under the changes proposed to the next edition of psychiatry's diagnostic manual, the DSM 5.

As the New York Times noted on Saturday in an article that rapidly became one of the most emailed, DSM 5 will have just one diagnosis for addiction problems, though it will be characterized as either mild, moderate or severe. Currently, alcohol and other drug problems come in two flavors.  The first, "substance abuse" is a short-term, self-limiting problem: it encompasses most heavy drinking in college.  The second "substance dependence," is what everyone else calls addiction or alcoholism and is typically chronic and marked by relapses.

Fortunately, the new diagnosis will get rid of the confusing term "dependence" (physically needing a drug to function isn't actually addiction) and the stigmatizing term "abuse." Unfortunately, however, it will also tremendously elevate the number of people considered alcoholics.  One Australian study suggested that using DSM 5 definitions will increase the number of people diagnosed with alcoholism by a stunning 60%.

Ian Urbina writes:

    "The chances of getting a diagnosis are going to be much greater, and this will artificially inflate the statistics considerably," said Thomas F. Babor, a psychiatric epidemiologist at the University of Connecticut who is an editor of the international journal Addiction. Many of those who get addiction diagnoses under the new guidelines would have only a mild problem, he said, and scarce resources for drug treatment in schools, prisons and health care settings would be misdirected.

    "These sorts of diagnoses could be a real embarrassment," Dr. Babor added.

Proponents of the new system argue that it will allow substance problems that might develop into serious addictions to be nipped in the bud:

    "We can treat them earlier," said Dr. Charles P. O'Brien, a professor of psychiatry at the University of Pennsylvania and the head of the group of researchers devising the manual's new addiction standards. "And we can stop them from getting to the point where they're going to need really expensive stuff like liver transplants."

Yet because it's impossible to determine which college bingers will moderate after graduation and who will go on to have lifetime problems, the distinction between abuse and dependence is difficult to pinpoint. The reality is that most college binge drinkers and drug users don't develop lifelong problems. But most addiction treatment programs encourage them to see themselves as having a chronic, relapsing disease that requires a lifetime of attendance at 12-step meetings to keep in check. Currently, about 31% of college students meet criteria for "alcohol abuse," while only 6% have the alcoholism-equivalent diagnosis of dependence.

Earlier editions of the DSM explicitly said there are alcohol and other drug problems that legitimately exist but do not reach the level of addiction; Alcoholics Anonymous itself differentiates between "problem drinkers" who can learn to moderate and alcoholics who can't. DSM 5 obliterates the distinction. If the change is finalized, anyone whose drinking or drug use creates any problems will essentially be an addict or alcoholic with a "mild" case of the disease and presumably, therefore, not someone who can learn control over his habits.

While researchers have been encouraging the widespread adoption of "brief interventions" and other techniques that don't require abstinence or a label— with great success— this change could swing the field in the opposite direction.

And that poses a huge problem, particularly for adolescents and young adults with mild problems who may be pushed to adopt an addict identity and to see themselves as having no way to control their drinking or drug use if they ever "relapse." Rather than empowering those who do have control to use it, these programs essentially tell kids that if they ever have just one drink or puff on a joint, they're lost.

(MORE: Does Teen Rehab Cure Addiction— Or Create It?)

While that strategy may help some people with addiction avoid relapse, research shows that it makes relapses worse if they do occur.  And given that the overwhelming majority of teens who are treated will not remain abstinent for life, this strategy is counterproductive for most who will be exposed to it.

In my years of covering addiction, I've heard the story dozens of times: someone with a mild problem enters treatment, is convinced they have a more severe case and meets others who help him or her get worse.  One teenage girl told me about meeting someone who turned her on to cocaine while in treatment for marijuana; another young man told me how treatment was the source of his perception that "who I was, was an alcoholic and drug addict."

Clearly, treatment for young people already labels too many of them as addicts and alcoholics; the last thing we need is the DSM legitimizing this harmful practice.  It should rename substance abuse "substance misuse," and label addiction, "addiction."  From any perspective, it's absurd to potentially label the 40% of college students who get drunk at least once a month as having "mild" alcoholism.

(MORE: DSM-5 Debate: Committee Backs Off Some Changes, Re-Opens Comments)

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at

[Neil]

The DSM lost credibility when they said that faggotry wasn't a disorder.

[garbon]

If it is impairing their ability to function/lead meaningful lives - sure why not?

[The Brain]

How do you get the diagnosis in the first place? You spend your college money on going to your doctor with a non-problem? And even if you're that stupid aren't medical records sealed?

[DGuller]

That's pretty alarming if true.  I think this warrants a lot of research into how you can redefine DSM 5 to bring down the percentage of alcoholics in college to an acceptable level.

[Ideologue]

Alcoholics Anonymous itself differentiates between "problem drinkers" who can learn to moderate and alcoholics who can't.

Yepper.

DSM 5 obliterates the distinction.

Ruh-roh.

[Jaron]

Jaron Trueheart

[Brazen]

Just been talking about DSM 5 in the context of military neuroscience. Given that every issue invents new conditions to meet the drugs being researched (see the surge in ADHD for example) there are probably new alcoholism treatments on the horizon.

How would you "treat" student (or journalist) binge drinking anyhow? Other than the way the British government is already going about it, by making beer £4 a pint

[derspiess]

In my book, an alcoholic is someone who is addicted to alcohol, period.  If someone just drinks a lot without any sort of addiction, he is just a heavy drinker. 

Back in 6th grade Health class we were shown a film that defined anyone who drinks alone as an alcoholic.  It then sarcastically identified social drinkers, who do not think of themselves as alcoholics, but actually are.  So the bottom line from the film is that anyone who drinks is an alcoholic.  All of us knew that was complete BS. 

The only redeeming feature of the film was when they got a fish drunk by pouring a little grain alcohol into the tank.

[CountDeMoney]

In my book, an alcoholic is someone who is addicted to alcohol, period.  If someone just drinks a lot without any sort of addiction, he is just a heavy drinker. 

How 1950s.

[derspiess]

In my book, an alcoholic is someone who is addicted to alcohol, period.  If someone just drinks a lot without any sort of addiction, he is just a heavy drinker. 

How 1950s.

Golden era.  Pity I couldn't experience it.

[CountDeMoney]

In my book, an alcoholic is someone who is addicted to alcohol, period.  If someone just drinks a lot without any sort of addiction, he is just a heavy drinker. 

How 1950s.

Golden era.  Pity I couldn't experience it.

Yes, you would have been right at home in the Birmingham PD. 

[derspiess]

Yes, you would have been right at home in the Birmingham PD. 

  Why do you jerks always have to bring up race whenever I pine for the 50s?

[CountDeMoney]

Yes, you would have been right at home in the Birmingham PD. 

  Why do you jerks always have to bring up race whenever I pine for the 50s?

Because you would've gone insane trapped in Leave It To Beaver.

[MadImmortalMan]

I knew a real alcoholic once. The guy got a DUI riding a bike and another because he was sleeping in the back seat of another dude's car and had started the motor so he could run the heater. He literally started puking if he wasn't constantly drunk.

I had to fire him. That was my first ever experience firing someone actually. I was 18.