Re: Substance Dependence was: sugar addiction, meds

[Guest guest]

Pete, I think you're absolutely right on here. First, I'm quite sure

you're right about the DSM and ICD. Second, I have to believe that

you're right about professionals' tendencies not to consult these

manuals when diagnosing patients, unless they're vastly distorting the

concepts therein. Third, you're correct in saying that American

insurance companies will accept either DSM or ICD coding for

reimbursement (not every single one -- some will accept only one or

the other). Under the Health Insurance Portability and Accountability

Act, passed in 1996, these terminologies should be standardized, so

only the ICD is used. (Interesting sidenote: in one website I

recently pulled up, there is both an American (DSM) and European

(ICD) definition of " alcoholism. " How many diseases can say that?)

Tolerance and withdrawal are not enough, alone, for a DSM diagnosis.

I can't say whether craving is required for an ICD diagnosis, but it

is included in the ICD definition and not the DSM.

I'm familiar with that " illegal using = harmful consequence " argument

and I think it's worth less than the paper it's written on. Plus the

" remission " BS -- it's self-contradictory. It just reflects the very

elastic standards that respected researchers -- such as Vaillant --

use to determine whether or not AA is effective.

It is not true, Pete, that any or all of the (I think) five (maybe

six) DSM criteria can be true for a diagnosis. There must be three or

more.

>

> > > My understanding is that professionals will diagnose

> " dependency "

> > > ONLY if there are repeated adverse consequences to the substance

> use,

> > > which the user is aware of. Physical tolerance/withdrawal can

> occur with

> > > OR without substance dependence.

> >

> > Not by definition.

>

> Actually I think you are both wrong here, but I'd have to check to

> make sure. The DSM doesnt use the words " addiction " and " addict "

> anywhere in it, (nor " alcoholism " or " alcholic " either). The ICD

> *does* use the word alcoholism, and I'm unsure about addiction.

> However, the ICD equivalent to Alcohol Dependence is Alcohol

> Dependence Syndrome, not " Chronic Alcoholism " which also exists in

it.

>

> IIRC DSM Alcohol/Substance Dependence is based on a number of

criteria

> that include all of Tolerance, Withdrawal and Harmful Consequences.

> However, none of these phenomena are either necessary or sufficient

to

> produce the dx; any or all of them can be present or absent.

>

> I understand the ICD is similar, but IIRC they include cravings,

which

> are not included in the DSM criteria. I think I have that the right

> way round!

>

> The US is odd in using both the DSM and the ICD as diagnostic

manuals;

> frequently a person could be dxed by the DSM and their insurance

> company billed by the ICD. Even the ICD comes in more than one

> version.

>

> Even odder is that many clinicians dont seem to know what the DSM

> actually says, in that they are under the impression one has to be

> totally abstinent to be in Full Remission from Dependence and in

fact

> one does not - nowhere does it says this. When challenged on this,

> they may be creative in justifying their view in termns of the

> criteria, ignoring the obvious point that if one had to be abstinent

> in order to be in Full Remission, then clearly the criterion of Full

> Remission would be simply " has not used the substance " - which it is

> not! Also they may be extremely creative in their interpretation of

> the criteria in order to hang the dx round someone's neck. A

cannibis

> user rarely suffers short term harmful consequences unless they are

> unlucky enough to get busted. " Repeated legal problems " is included

> as a possible harmful consequence, which is probably reasonable, but

I

> have seen one clinician basically claim that simply *using* an

illegal

> drug, as it meant breaking the law, meant that the person had

> " repeated legal problems " and hence fulfilled this criterion!

Clearly

> (to me anyway) this phrase is meant to refer to actual legal

penalties

> such as busts or maybe driving under the influence or other

antisocial

> behavior, rather than simply breaking the possession laws without

> being caught, and I shudder to think of the number of non-dependent

> individuals who are deemed to be or are only in " Partial Remission "

> because of these zealous interpretations - and the consequences

there

> might be thereof. Even the term " remission " of course, suggests a

> chronic recurring condition rather than one that one can completely

> recover from.

>

> P.

[Guest guest]

Pete, I think you're absolutely right on here. First, I'm quite sure

you're right about the DSM and ICD. Second, I have to believe that

you're right about professionals' tendencies not to consult these

manuals when diagnosing patients, unless they're vastly distorting the

concepts therein. Third, you're correct in saying that American

insurance companies will accept either DSM or ICD coding for

reimbursement (not every single one -- some will accept only one or

the other). Under the Health Insurance Portability and Accountability

Act, passed in 1996, these terminologies should be standardized, so

only the ICD is used. (Interesting sidenote: in one website I

recently pulled up, there is both an American (DSM) and European

(ICD) definition of " alcoholism. " How many diseases can say that?)

Tolerance and withdrawal are not enough, alone, for a DSM diagnosis.

I can't say whether craving is required for an ICD diagnosis, but it

is included in the ICD definition and not the DSM.

I'm familiar with that " illegal using = harmful consequence " argument

and I think it's worth less than the paper it's written on. Plus the

" remission " BS -- it's self-contradictory. It just reflects the very

elastic standards that respected researchers -- such as Vaillant --

use to determine whether or not AA is effective.

It is not true, Pete, that any or all of the (I think) five (maybe

six) DSM criteria can be true for a diagnosis. There must be three or

more.

>

> > > My understanding is that professionals will diagnose

> " dependency "

> > > ONLY if there are repeated adverse consequences to the substance

> use,

> > > which the user is aware of. Physical tolerance/withdrawal can

> occur with

> > > OR without substance dependence.

> >

> > Not by definition.

>

> Actually I think you are both wrong here, but I'd have to check to

> make sure. The DSM doesnt use the words " addiction " and " addict "

> anywhere in it, (nor " alcoholism " or " alcholic " either). The ICD

> *does* use the word alcoholism, and I'm unsure about addiction.

> However, the ICD equivalent to Alcohol Dependence is Alcohol

> Dependence Syndrome, not " Chronic Alcoholism " which also exists in

it.

>

> IIRC DSM Alcohol/Substance Dependence is based on a number of

criteria

> that include all of Tolerance, Withdrawal and Harmful Consequences.

> However, none of these phenomena are either necessary or sufficient

to

> produce the dx; any or all of them can be present or absent.

>

> I understand the ICD is similar, but IIRC they include cravings,

which

> are not included in the DSM criteria. I think I have that the right

> way round!

>

> The US is odd in using both the DSM and the ICD as diagnostic

manuals;

> frequently a person could be dxed by the DSM and their insurance

> company billed by the ICD. Even the ICD comes in more than one

> version.

>

> Even odder is that many clinicians dont seem to know what the DSM

> actually says, in that they are under the impression one has to be

> totally abstinent to be in Full Remission from Dependence and in

fact

> one does not - nowhere does it says this. When challenged on this,

> they may be creative in justifying their view in termns of the

> criteria, ignoring the obvious point that if one had to be abstinent

> in order to be in Full Remission, then clearly the criterion of Full

> Remission would be simply " has not used the substance " - which it is

> not! Also they may be extremely creative in their interpretation of

> the criteria in order to hang the dx round someone's neck. A

cannibis

> user rarely suffers short term harmful consequences unless they are

> unlucky enough to get busted. " Repeated legal problems " is included

> as a possible harmful consequence, which is probably reasonable, but

I

> have seen one clinician basically claim that simply *using* an

illegal

> drug, as it meant breaking the law, meant that the person had

> " repeated legal problems " and hence fulfilled this criterion!

Clearly

> (to me anyway) this phrase is meant to refer to actual legal

penalties

> such as busts or maybe driving under the influence or other

antisocial

> behavior, rather than simply breaking the possession laws without

> being caught, and I shudder to think of the number of non-dependent

> individuals who are deemed to be or are only in " Partial Remission "

> because of these zealous interpretations - and the consequences

there

> might be thereof. Even the term " remission " of course, suggests a

> chronic recurring condition rather than one that one can completely

> recover from.

>

> P.

[Guest guest]

Pete, I think you're absolutely right on here. First, I'm quite sure

you're right about the DSM and ICD. Second, I have to believe that

you're right about professionals' tendencies not to consult these

manuals when diagnosing patients, unless they're vastly distorting the

concepts therein. Third, you're correct in saying that American

insurance companies will accept either DSM or ICD coding for

reimbursement (not every single one -- some will accept only one or

the other). Under the Health Insurance Portability and Accountability

Act, passed in 1996, these terminologies should be standardized, so

only the ICD is used. (Interesting sidenote: in one website I

recently pulled up, there is both an American (DSM) and European

(ICD) definition of " alcoholism. " How many diseases can say that?)

Tolerance and withdrawal are not enough, alone, for a DSM diagnosis.

I can't say whether craving is required for an ICD diagnosis, but it

is included in the ICD definition and not the DSM.

I'm familiar with that " illegal using = harmful consequence " argument

and I think it's worth less than the paper it's written on. Plus the

" remission " BS -- it's self-contradictory. It just reflects the very

elastic standards that respected researchers -- such as Vaillant --

use to determine whether or not AA is effective.

It is not true, Pete, that any or all of the (I think) five (maybe

six) DSM criteria can be true for a diagnosis. There must be three or

more.

>

> > > My understanding is that professionals will diagnose

> " dependency "

> > > ONLY if there are repeated adverse consequences to the substance

> use,

> > > which the user is aware of. Physical tolerance/withdrawal can

> occur with

> > > OR without substance dependence.

> >

> > Not by definition.

>

> Actually I think you are both wrong here, but I'd have to check to

> make sure. The DSM doesnt use the words " addiction " and " addict "

> anywhere in it, (nor " alcoholism " or " alcholic " either). The ICD

> *does* use the word alcoholism, and I'm unsure about addiction.

> However, the ICD equivalent to Alcohol Dependence is Alcohol

> Dependence Syndrome, not " Chronic Alcoholism " which also exists in

it.

>

> IIRC DSM Alcohol/Substance Dependence is based on a number of

criteria

> that include all of Tolerance, Withdrawal and Harmful Consequences.

> However, none of these phenomena are either necessary or sufficient

to

> produce the dx; any or all of them can be present or absent.

>

> I understand the ICD is similar, but IIRC they include cravings,

which

> are not included in the DSM criteria. I think I have that the right

> way round!

>

> The US is odd in using both the DSM and the ICD as diagnostic

manuals;

> frequently a person could be dxed by the DSM and their insurance

> company billed by the ICD. Even the ICD comes in more than one

> version.

>

> Even odder is that many clinicians dont seem to know what the DSM

> actually says, in that they are under the impression one has to be

> totally abstinent to be in Full Remission from Dependence and in

fact

> one does not - nowhere does it says this. When challenged on this,

> they may be creative in justifying their view in termns of the

> criteria, ignoring the obvious point that if one had to be abstinent

> in order to be in Full Remission, then clearly the criterion of Full

> Remission would be simply " has not used the substance " - which it is

> not! Also they may be extremely creative in their interpretation of

> the criteria in order to hang the dx round someone's neck. A

cannibis

> user rarely suffers short term harmful consequences unless they are

> unlucky enough to get busted. " Repeated legal problems " is included

> as a possible harmful consequence, which is probably reasonable, but

I

> have seen one clinician basically claim that simply *using* an

illegal

> drug, as it meant breaking the law, meant that the person had

> " repeated legal problems " and hence fulfilled this criterion!

Clearly

> (to me anyway) this phrase is meant to refer to actual legal

penalties

> such as busts or maybe driving under the influence or other

antisocial

> behavior, rather than simply breaking the possession laws without

> being caught, and I shudder to think of the number of non-dependent

> individuals who are deemed to be or are only in " Partial Remission "

> because of these zealous interpretations - and the consequences

there

> might be thereof. Even the term " remission " of course, suggests a

> chronic recurring condition rather than one that one can completely

> recover from.

>

> P.

[Guest guest]

> Pete, I think you're absolutely right on here. First, I'm quite

> It is not true, Pete, that any or all of the (I think) five (maybe

> six) DSM criteria can be true for a diagnosis. There must be three

or

> more.

I meant of the three we were discussing (tolerance, withdrawal, and

harmful consequences). If there are 6 criteria (I cant rememeber) then

all 3 of these could be absent, but in any case my point was that none

of them are either necessary or sufficient for the dx.

P.

[Guest guest]

Okay, Pete, I see what you mean. The misunderstanding is that I

seem to remember (but may be wrong) that the other criteria, besides

tolerance and withdrawal, all fall in the harmful consequences

category. Why don't I look it up and get back to the list.

> > Pete, I think you're absolutely right on here. First, I'm quite

>

> > It is not true, Pete, that any or all of the (I think) five (maybe

> > six) DSM criteria can be true for a diagnosis. There must be

three

> or

> > more.

>

> I meant of the three we were discussing (tolerance, withdrawal, and

> harmful consequences). If there are 6 criteria (I cant rememeber)

then

> all 3 of these could be absent, but in any case my point was that

none

> of them are either necessary or sufficient for the dx.

>

> P.

[Guest guest]

I think this is right, but there is no attribution to the source:

A.Alcohol abuse: A destructive pattern of alcohol use, leading to

significant social, occupational, or medical impairment.

B.Must have three (or more) of the following, occurring when the

alcohol use was at its worst:

1.Alcohol tolerance: Either need for markedly increased

amounts of alcohol to achieve intoxication, or markedly

diminished effect with continued use of the same amount of

alcohol.

2.Alcohol withdrawal symptoms: Either (a) or (.

(a) Two (or more) of the following, developing within

several hours to a few days of reduction in heavy or prolonged

alcohol use:

sweating or rapid pulse

increased hand tremor

insomnia

nausea or vomiting

physical agitation

anxiety

transient visual, tactile, or auditory hallucinations

or illusions

grand mal seizures

( Alcohol is taken to relieve or avoid withdrawal

symptoms.

3.Alcohol was often taken in larger amounts or over a longer

period than was intended

4.Persistent desire or unsuccessful efforts to cut down or

control alcohol use

5.Great deal of time spent in using alcohol, or recovering

from hangovers

6.Important social, occupational, or recreational activities

given up or reduced because of alcohol use.

7.Alcohol use is continued despite knowledge of having a

persistent or recurrent physical or psychological problem that

is likely to have been worsened by alcohol (e.g., continued

drinking despite knowing that an ulcer was made worse

by drinking alcohol)

> > > Pete, I think you're absolutely right on here. First, I'm quite

> >

> > > It is not true, Pete, that any or all of the (I think) five

(maybe

> > > six) DSM criteria can be true for a diagnosis. There must be

> three

> > or

> > > more.

> >

> > I meant of the three we were discussing (tolerance, withdrawal,

and

> > harmful consequences). If there are 6 criteria (I cant rememeber)

> then

> > all 3 of these could be absent, but in any case my point was that

> none

> > of them are either necessary or sufficient for the dx.

> >

> > P.

[Guest guest]

I think this is right, but there is no attribution to the source:

A.Alcohol abuse: A destructive pattern of alcohol use, leading to

significant social, occupational, or medical impairment.

B.Must have three (or more) of the following, occurring when the

alcohol use was at its worst:

1.Alcohol tolerance: Either need for markedly increased

amounts of alcohol to achieve intoxication, or markedly

diminished effect with continued use of the same amount of

alcohol.

2.Alcohol withdrawal symptoms: Either (a) or (.

(a) Two (or more) of the following, developing within

several hours to a few days of reduction in heavy or prolonged

alcohol use:

sweating or rapid pulse

increased hand tremor

insomnia

nausea or vomiting

physical agitation

anxiety

transient visual, tactile, or auditory hallucinations

or illusions

grand mal seizures

( Alcohol is taken to relieve or avoid withdrawal

symptoms.

3.Alcohol was often taken in larger amounts or over a longer

period than was intended

4.Persistent desire or unsuccessful efforts to cut down or

control alcohol use

5.Great deal of time spent in using alcohol, or recovering

from hangovers

6.Important social, occupational, or recreational activities

given up or reduced because of alcohol use.

7.Alcohol use is continued despite knowledge of having a

persistent or recurrent physical or psychological problem that

is likely to have been worsened by alcohol (e.g., continued

drinking despite knowing that an ulcer was made worse

by drinking alcohol)

> > > Pete, I think you're absolutely right on here. First, I'm quite

> >

> > > It is not true, Pete, that any or all of the (I think) five

(maybe

> > > six) DSM criteria can be true for a diagnosis. There must be

> three

> > or

> > > more.

> >

> > I meant of the three we were discussing (tolerance, withdrawal,

and

> > harmful consequences). If there are 6 criteria (I cant rememeber)

> then

> > all 3 of these could be absent, but in any case my point was that

> none

> > of them are either necessary or sufficient for the dx.

> >

> > P.

[Guest guest]

I think this is right, but there is no attribution to the source:

A.Alcohol abuse: A destructive pattern of alcohol use, leading to

significant social, occupational, or medical impairment.

B.Must have three (or more) of the following, occurring when the

alcohol use was at its worst:

1.Alcohol tolerance: Either need for markedly increased

amounts of alcohol to achieve intoxication, or markedly

diminished effect with continued use of the same amount of

alcohol.

2.Alcohol withdrawal symptoms: Either (a) or (.

(a) Two (or more) of the following, developing within

several hours to a few days of reduction in heavy or prolonged

alcohol use:

sweating or rapid pulse

increased hand tremor

insomnia

nausea or vomiting

physical agitation

anxiety

transient visual, tactile, or auditory hallucinations

or illusions

grand mal seizures

( Alcohol is taken to relieve or avoid withdrawal

symptoms.

3.Alcohol was often taken in larger amounts or over a longer

period than was intended

4.Persistent desire or unsuccessful efforts to cut down or

control alcohol use

5.Great deal of time spent in using alcohol, or recovering

from hangovers

6.Important social, occupational, or recreational activities

given up or reduced because of alcohol use.

7.Alcohol use is continued despite knowledge of having a

persistent or recurrent physical or psychological problem that

is likely to have been worsened by alcohol (e.g., continued

drinking despite knowing that an ulcer was made worse

by drinking alcohol)

> > > Pete, I think you're absolutely right on here. First, I'm quite

> >

> > > It is not true, Pete, that any or all of the (I think) five

(maybe

> > > six) DSM criteria can be true for a diagnosis. There must be

> three

> > or

> > > more.

> >

> > I meant of the three we were discussing (tolerance, withdrawal,

and

> > harmful consequences). If there are 6 criteria (I cant rememeber)

> then

> > all 3 of these could be absent, but in any case my point was that

> none

> > of them are either necessary or sufficient for the dx.

> >

> > P.