DSM – IV, DSM-V, ASAM and Other Concepts
This epistle was provoked by current machinations relating to current ASAM, DSM-V, SAMHSA, NIH and other behavioral health diagnostic concepts. The collective analysis of these creations has resulted in a personal “Peter Principal”. I am unable to understand what went through the minds of the people creating these programs. Their creations are based on 40 years of ineffective substance abuse treatment and results. The new perspectives seem to suggest that more complex processes will provide better solutions.
One of the first sayings I heard when I started AA/NA meetings was: Use the “KISS” principal. (Keep it Simple Stupid)
Note: While I’m thinking of AA, the following information might be enlightening. When the two founders of AA started the organization in 1936, they developed certain traditions that are unique to AA. These traditions prevent any organizational activities that would interfere with the main purpose of AA – which is to assist individuals to improve their behaviors. There are approximately 2 million participants in AA; but, the organization has no regular employees or officers, owns no property and doesn’t advertise. Each meeting is self supporting and voluntarily staffed. These traditions are so KISS oriented they are profound. No other organization that I know of operates in this fashion.
We human beings find this KISS principal too simplistic. We need more creative solutions. We need solutions that require training and education to understand. We need to feel we provide unique solutions because we are so much brighter than other species.
There are hundreds of diagnostic creations that clinicians have developed to determine how individuals should be managed to provide positive treatment results. A key question might be: “were these developed because other tools weren’t effective.” If so, we have quite a collection of ineffective tools.
A key to changing individual behaviors is to convince an individual, or client, that they need to change their behaviors. Diagnostic results and presentation are key elements, when convincing a person that changes are needed. They need to be accurate, comprehensive, understandable, objective and self diagnosis.
AA/NA membership requires that a person just “wants to stop using alcohol/drugs.” Fortunately, the individual has taken the first step toward behavior improvement. They are at a meeting of like folks – who support accountability – and get results – comparable to organized treatment.
Although the CAGE questionnaire has been endorsed by some Federal agencies and contains four meaningful questions, the results presentation to the client may not be definitive enough to be consistently accepted by the client.
I believe, the Interview Techniques processes presented by Dr. Jon Weinberg in 1972 is a practical KISS tool. This tool determines if alcohol/drug use has negatively affected any of the individual’s life areas. (Occupational, Financial, Health, Social, Legal or Family) If any of these life areas have been negatively affected, it is clear evidence that client actions have resulted in serious life consequences.
The direct correlations between alcohol/drug use, abuse or addiction and the negative life area consequences are hard to dispute and can be convincing. TEAM treatment processes can also use “life-area” TEAM members to enhance treatment results.
Below, I have enclosed information about DSM-V, ASAM, SAMHSA, NIH and other diagnostic concepts. This information has been included to provide examples of how our non-KISS tools have become so complex that they are hard to understand and will provide the same statistical results as their predecessors have for the last 40 years.
ASAM States: “Addiction is a primary, chronic disease”.
DSM-V States: Every drug, including alcohol, has a separate “disorder” classification. Each disorder can be mild, moderate or severe. There are approximately 100 disorders and treatment categories. This mental disorder bible also claims that legal issues should no longer be used as diagnosis criteria. (If you have 5 dwi’s, don’t fret.)
ASAM vs DSM-V: If addiction is a disease, it seems implausible that you can be a little bit addicted. Kind of like being a little bit pregnant. If addiction is a clinically defined collection of circumstances, how does the patient become convinced they need a variety of treatment modalities?
SAMHSA: This agency has now defined drug addiction as a “Behavioral Health” issue. In a 262 page document, this agency describes how clinicians can determine which of the 100 DSM-V disorders should be used and how to diagnose mild, moderate or severe abuse and dependence.
It is this addict’s opinion: government and treatment entities have created new imaginative processes that try to justify previous efforts and the trillions of dollars spent with no statistical improvements. This eliminates the need to be Accountable. This also supports the need for more funds and creations. Statistics support my conclusions.
The Illustrations shown below support issues noted above.
Drug Problem when I was a kid
Teen Self Assessment Results
CAGE and Weinberg’s Life Areas
ASAM – DSM-IV – DSM-V
SAMHSA Review of DSM-V Criteria
A Review of the Disorders that need to be considered
The Link below will provide you with a PDF that contains the information included in this post.