I know my mother worried about it, though when she broached the subject – none too subtly – I’m not certain she believed me when I said simply, “I know better.”
Sure, sometimes I rolled my eyes and shook my head when I answered, in part because I thought she knew me better.
I didn’t drink. I didn’t do drugs. I didn’t screw around.
But now that I’m a parent, and having dealt with adolescents for many years, I get it.
I get the fear, if your kids are in college and you have no idea what they’re doing when they socialize. I get the incessant worry, even if they’re still under your roof, and basically, you trust your teenager.
I get the bigger picture view – the breadth of appalling possibilities that flash through your mind when you envision kids and substance abuse – drugs, alcohol, cigarettes, and more. When we’re young, we’re convinced we’re immortal.
Kids and Drugs
We don’t seem to anticipate the extent of the problem – or potential problem. (Shall we revisit the issue of students, prescription drugs, and SATs?)
We don’t imagine how easy it is for kids (in nice suburban schools) to get their hands on whatever they want – at least – to hear some of them talk.
We don’t imagine those all night parties at frat houses, downing alcohol in quantities sufficient to break down all inhibitions or to send kids to the hospital.
Sex, drugs, and rock ‘n roll? I loved the rock ‘n roll, like every other teenager, but as for the rest – I knew myself well at the time – what I wanted and did not, what risks I was willing to take, and those I would walk away from. Thinking back to my own adolescence, plenty of my friends drank, though more smoked pot. What else were they up to? I didn’t pay attention. Personally, I was focused on my future and academics, and I like having my wits about me.
But times, they are-a-changing. Or have changed, as drugs are more accessible than ever – not only in college and high schools, but middle schools and elementary schools – and that includes legal drugs.
And it isn’t just drugs we worry about. It’s self-destructive behaviors that may slide into compulsion.
Do Definitions Matter? Abuse, by Any Other Name?
I came across an interesting article at The Fix, a site that specializes in dealing with the addiction community from all angles, including policy changes and treatment attitudes.
The feature is an article on the all important DSM. For those of you who may not be familiar with this reference, the DSM is the Diagnostic and Statistical Manual of Mental Disorders. In short, it is what it sounds like – the Bible to those professionals who deal with mental health conditions. And as you might imagine, the definitions included in the DSM have sweeping impacts on treatment options, insurance, not to mention what Big Pharma is up to.
I quote from the article by Dr. Richard Juman, as he assesses the proposed revisions to the DSM, first by situating the difficulty of these definitions:
Since psychiatric disorders don’t announce themselves with biological diagnostic data, the coherent organization of a huge number of complex disorders into a “manual” to be used by researchers, healthcare professionals and third-party payers is daunting. How do you capture, in a few pages, illnesses and patterns of suffering that manifest uniquely in every new patient?
A gargantuan task, indeed.
He goes on to explain the three main areas of change as:
Adding “craving or a strong desire to use” as a criterion; replacing the separate categories of substance “abuse” and “dependence” with a unified “Substance Use Disorder” rated for severity (Alcohol Use Disorder, say, or Severe Cocaine Use Disorder); adding Gambling Disorder to the Addictive Disorders, where previously Pathological Gambling was listed as an Impulse Control Disorder. (This change likely paves the way for other Addictive Disorders in future editions, such as sex addiction and internet addiction.)
Slippery Slope?
I am not a psychologist, psychiatrist, or other health care professional, but I can easily put two and two together and see the potentially slippery slope. Might any (destructive) behavior be deemed a “syndrome” and distract us from dealing with our societal ills by turning to Big Pharma?
Does inclusion in the DSM always mean less stigma and more legitimacy to problem behaviors, so this may be a positive step?
Will these changes cause us to shortchange the very real assistance to be gained through talk therapy, or at least, some combined effort when it comes to treatment for these “disorders?”
The article references issues of binge drinking in college, legitimate worries about “false epidemics,” and other implications. (Read the article – it’s fascinating, even for a layman.)
Dr. Juman states:
Along with the fear of unnecessary diagnoses comes the fear of unnecessary pharmacologic treatments. Critics argue that the changes in the diagnostic criteria and the availability of psychotropic medications for cravings may lead to an increase in the use of prescription drugs for the disorders. They also complain about the financial ties to the pharmaceutical industry among some of the clinicians responsible for drafting the revision.
I would agree with Dr. Juman’s perspective that pharmacological solutions alone may not be the best call. Pressure, depression, self-esteem issues, family issues – all may trigger emotions we are hard-pressed to deal with alone, and so we turn to whatever eases the pain or numbs it. Talk therapy could be the differentiator, but then again, there is less stigma to a pill than a shrink, not to mention less cost.
And isn’t that a considerable problem, whatever condition we’re trying to treat?
A Parent’s Job: Worry?
I can only comment on these proposed DSM changes as a parent, and a member of the greater community of Americans who are directly and indirectly touched by addictions of all sorts. And we are all touched in some way, aren’t we? Ethically, economically, emotionally?
Think about our health care system.
Think about our crime rates.
Think about our tax dollars.
Think about our growing isolation, our kids, our neighbors, our schools, our city streets.
Think about the waste of lives.
Yet my greatest worry is for the issues in society that we aren’t addressing – or addressing sufficiently which I see as root causes for at least a portion of our substance abuse ills.
- What’s your take on considering extreme (dependent) Internet usage as an addiction?
- What about sex? What about food abuse?
- Do you worry about labeling certain destructive behaviors as “disorders?”
- How do we keep the pharmaceutical industry from pushing more pills down our throats (with an assist from certain physicians?), rather than dealing with root causes?
- Do you see these changes as a step in the right direction toward access to solutions?
Note: Salon.com offers commentary on Dr. Juman’s article in The Fix as well.
You May Also Enjoy
The DSM serves the purpose of helping clinicians – not physicians (except maybe psychiatrists) to diagnose a patient and help them through the healing process. Psychiatrists, therapists, etc recognize the difficulties in using the DSM exclusively which is why they also rely on regular check-ups and appointments to determine how a patient is doing.
The problem in our current system is that many people see a primary care physician when they are experiencing difficulties. PCP’s are not trained in psychiatry. Many of them are unfamiliar with psychotropic medications and either over-prescribe or mis-prescribe them which leads to other complications. There isn’t any particular person at fault here, it’s the product of a dysfunctional system, one that is sick-centered rather than well-centered. People in all categories are hurt by this – those who are legitimately mentally ill and those who have what is termed short-term depression or situational depression/anxiety (the difference being things that have happened to spark an episode rather than having life long symptoms). Those of us with mental illness will seek help from PCPs since they are the easiest to access and will face misdiagnoses or absolute rude behavior from physicians (most people do not hear the stories that many of us share – physicians who tell us it’s all in our heads when things are NOT OKAY). While those who do not have mental illness but are struggling with life changes that lead to depression and anxiety are given prescriptions rather than suggestions for therapy or diet. It’s a tough balance.
As for substance abuse and calling them disorders, there are legitimate disorders when it comes to abuse -internet, sex, alcohol, illicit drugs, etc – but there are other forms. The reason, I think, the DSM changed them is because a disorder is treated differently than abuse. For example, a person who abuses alcohol because they have recently divorced or lost a job or someone close to them died will often abuse alcohol for a few months and return to normal consumption. Those that have a disorder, or are alcoholics, will have a life long pattern of abuse and leave a trail of destructive behaviors behind. Their alcohol, though, is usually a comorbidity of some untreated mental illness or something very serious from their past (like sexual abuse). The same can be said of other abuses-turned-disorders.
Honestly, medications are important. But, and those who have mental illness will openly tell anyone this, they don’t heal anything. It’s a combination of those plus other therapies that help a person live life somewhat normally (by normally I mean as a functioning person rather than one drowned in ridiculous worries and severe sorrow that affect their quality of life). However, pharmaceutical companies and physicians often overuse them so that they aren’t used appropriately or efficiently. Again, it’s a symptom of our current healthcare system that maybe, just maybe, Obamacare will help alleviate. (Though I think it will take more changes than this healthcare bill to get us to a better point, but this is a positive start.)
I find it more than a little disturbing that insurance and pharmaceutical companies drive so much of what goes on in medicine. Let’s face it, mental health illnesses still come with a stigma, both societal and with the insurance companies (you might as well have cancer – because it will label you in a negative way that can lead to higher premiums). On the other hand, pharmaceutical companies love all illnesses. They fund most research in the medical field, and most clinical trials are all about new medicines trying to make it to the market.
I don’t know whether these changes to the DSM will make patient treatment suffer or not. It seems like there is a desire to meet problems early on before they become full-blown addictions. But, it also seems like everything is a disorder, a syndrome, or an addiction these days. I am certainly not an expert, but I don’t know if I consider some behaviors to be addictions. To my understanding, addiction has to do with physical dependency, a change in brain chemistry, and when the substance (or whatever) is removed, the patient undergoes withdrawal (physical or psychological). Can a person have withdrawal symptoms if you take away their Internet or keep them from gambling? I don’t know the criteria for how the researchers have developed their findings for the DSM, but some behaviors don’t seem to be true addictions.
In the end, it comes down to who is footing the bill. Insurance companies don’t want to spend money and that restricts patients’ options, while pharmaceutical companies want to sell their products, which can also limit patients’ options (because it might prove to be a cheaper treatment that the insurance company will agree to pay for versus other treatments such as talk therapy). Both types of companies have their bottom line in mind, and I think it affects the care that people receive.
But I LIKE Rock ‘n Roll.
(sex, obviously)
Excellent comments… (Paul, I love rock ‘n roll, too… And, well… You know.). 🙂
From my loose point of connection with the DSM (having a family member with what I believe to be mental illness), I have liked the direction in which I have seen it going.
However, two experts have recently resigned from the DSM-V working group, citing domination by a few membes who reject the opinions of others, as well as scientific evidence. They believe that the direction of the group may cause (at least inadvertently) the new guidelines to result in the increased recruitment of patients and pharmaceutical customers.
Here is the link:
http://www.borderlinepersonalitydisorder.com/blog/information-news-corner/ubc-prof-emeritus-john-livesley-and-dutch-expert-quit-dsm-v-committee-defining-personality-disorde-2/