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What’s New in DSM-5
For Clinicians Working with Mandated
Populations
State Specialty Court Conference
DuAne L. Young • The Change Companies®
Gen
era
l Overv
iew
of
the D
SM
-5
• Concept of Axes is gone… no Axis I to V
• Personality Disorders remain but are no longer secondary (on par with Axis I)
• GAF scores are no longer assigned
Gen
era
l Overv
iew
of
the D
SM
-5
• Most common diagnoses have minimal changes regarding core symptoms
• Some disorders are in new sections
• Personality Disorders remain the same
Gen
era
l Overv
iew
of
the D
SM
-5
• Bipolar Disorders is now in a separate section – the criteria are essentially the same
• PTSD is now in a new section for Trauma and Stressor Related Disorders
• Obsessive/Compulsive Disorder is in a new section with other compulsive disorders
Disruptive Mood
Deregulation
Disorder –
Essentially temper
tantrums with
persistent anger or
irritability
“Hot” topics
Dependence has a biological basis and is not just a more serious form
of abuse
Dependence produces distinct and striking problem prevalence
Dependence is a discrete syndrome of varying
severity
• Abuse may not have a biological component
• Problem areas for abuse tend to be more limited than with dependence
• Abuse is diagnostically distinct from dependence
Changes in diagnoses from dependence to abuse do not tend to occur – either continued dependence or recovery is more typical
Sub
stance
Use
D
isord
ers
• Replace abuse & dependence with “mild substance use disorder,, “moderate substance use disorder” & “severe substance use disorder”
• Combine 11 criteria into a single continuum of criteria
Sub
stance
Use
D
isord
ers
• Legal problems related to use are no longer part of the criteria… replaced with craving/compulsion to use
• Early remission now 3 months
• Craving only criterion that can be present in remission
DSM-5 Alcohol Use Disorder
1. Substance taken in larger amounts over a longer period than intended.
2. Persistent desire to cut down or control usage.
3. Significant time spent obtaining, using & recovering from substance use.
4. Use resulting in failure to fulfill major role obligations.
5. Continued use despite recurrent social or interpersonal problems.
6. Social, occupational or recreational activities given up or reduced.
7. Use in situations that are physically hazardous.
8. Continued use despite known recurrent physical or psychological problems likely caused by use.
DSM-5 Alcohol Use Disorder
9. Tolerance: Use more to get the same effect and/or effects diminished with same amount.
10. Withdrawal symptoms (Criteria A & B for withdrawal).
11. Craving or strong desire or urge to use.
DSM-5 Alcohol Use Disorder
Severity
Sca
le0–1 criteria = No diagnosis
2–3 criteria = Mild substance use disorder
4–5 criteria = Moderate substance use disorder
6+ criteria = Severe substance use disorder
Continuum of use
No Diagnosis
Mild Substance
Use Disorder
Moderate
Substance Use
Disorder
Severe Substance
Use Disorder
Implications for our field
• What does removal of legal criteria mean for assessment & placement of mandated clients?
• How do the overall behavioral health changes impact placement?
• How will the majority of our clients fall within the continuum of use?
• Brief assessments • Comprehensive & co-occurring* Placement &
Planning * Workforce & SAP
Evaluations * Outcome
Evaluations
The Change Companies® Evince Clinical
Assessments