Long before I discovered the Big Book, I was infatuated with another big book: the DSM-III-R. I know, it sounds riveting, doesn’t it? DSM stands for Diagnostic and Statistical Manual of Mental Disorders, and I had to buy it for an undergraduate class in clinical psychology. Anyone can buy the DSM, but having it made me feel more competent as a 19 year-old student and intern. Its no-nonsense format seemed to compensate for my lack of life experience and maturity.
I chose psychology as a major because I didn’t want to be a teacher and I once saw a riveting documentary on HBO about schizophrenics. I envy those who always knew what they wanted to be when they grew up because I’m still deciding. Yet we’re forced at a young age to choose something…anything, and I chose psychology because it was interesting and math and public speaking were terrifying.
I hadn’t accounted for all the public speaking in psychology internships, though. My first experience in the field was as a co-leader for a group of “at risk” teens at a private Lutheran school. They were all white kids of privilege, but still I felt eaten alive. I had no idea what I was doing there or at my next placement, which was at an outpatient substance abuse treatment center, even though I requested the place where people went to get over their fear of elevators or snakes or snakes in elevators.
How ironic is it that I was sent to educate adolescents about the dangers of substance abuse while I was drinking and smoking pot and enjoying the hell out of both? I felt like such a hypocrite, a real fraud.
I still have my old DSM in a box in the basement, although it’s been updated twice since then. What we know about the mind seems to be ever-evolving and fluid, and the American Psychiatric Association is now accepting feedback on proposed changes for the DSM-V. In this latest version, due out next year, substance abuse and substance dependence – once two separate categories – will be lumped together as substance use disorder.
To see the proposed criteria for alcohol use disorder, click here.
You’re never going to make everybody happy with change, and the DSM is no exception. By combining substance abuse and dependence into one category, some fear those with intermittent, almost accidental histories will be stigmatized unnecessarily. The removal of one criteria, “problems with law enforcement” (ie DUIs), would suggest otherwise, though, especially since it’s being taken out because it was so rare, even among those already in treatment. From what I’ve read, the APA lumped both categories together because the distinctions between alcohol abuse and dependence were murky, yet the treatment was often the same anyway.
As an alcoholic, the changes won’t effect me unless I seek professional treatment, and then the only change will be to the code my doctor uses to bill my insurance company. Just like I never see this paperwork, I’ll never see the new DSM because it’s just a book of diagnoses and I got out of the field soon after college.
I like to think the changes are a step in the right direction – a better understanding of alcoholism as a physical disease – but alcoholism feels more like a spiritual affliction. I don’t mean that it’s not also physical, because it is. My body and mind responded in physical, predictable ways after years of abuse. But the way I abused alcohol was unusual from the start. I never drank like a normal person, and there is something there that I don’t know if the medical profession is anywhere near understanding. In the end, it doesn’t really matter because “the cure” is older than the first edition DSM in 1952. I have a big book now with answers old and obvious, and the only difference is I’m in a place to hear them.