Author Topic: "dependence" is now a Substance Use Disorder?  (Read 889 times)

[Buddie]

"dependence" is now a Substance Use Disorder?
« on: April 11, 2022, 03:37:55 pm »
Why are we still using the word dependence to define our condition if back in 2013 they (APA) redefined what dependence is?

The APA (the American Psychiatric Association) in 2013 lumped substance dependence together with substance abuse (!) as just one category called substance use disorder! So they no longer need to be recognized as separate conditions? The problem I see is that obviously our reality, public perception and medical treatment of dependence vs abuse is totally different (and wrong in many respects).

Quote:
"In the DSM-5 (released in 2013), substance abuse and substance dependence have been merged into the category of substance use disorders and they no longer exist as individual diagnoses." https://en.wikipedia.org/wiki/Substance_dependence

I think this link provides a summary of relevant section: https://digitalprairie.ok.gov/digital/collection/stgovpub/id/350512
so why do we say "dependence" if now they say:
"SUBSTANCE-RELATED AND ADDICTIVE DISORDERS
• Neither tolerance nor withdrawal is necessary to diagnose a substance-use disorder
Symptoms of tolerance and withdrawal from prescribed medications taken as directed is not substance use disorder"

What would make more sense is calling it more what it actually is, an acquired brain injury https://en.wikipedia.org/wiki/Acquired_brain_injury
Notice that I'm not saying "permanent" because the suffering from this brain injury does lead to recovery.
 
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[Buddie]

Re: "dependence" is now a Substance Use Disorder?
« Reply #1 on: April 15, 2022, 06:45:45 pm »
Funny, the genius Drs put us on the addictive *hit in the first place.

I'm so glad I don't see Drs anymore. I've been to some real losers.

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[Buddie]

Re: "dependence" is now a Substance Use Disorder?
« Reply #2 on: April 19, 2022, 04:06:49 am »
This is why "physical dependence" is better than dependence.
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[Buddie]

Re: "dependence" is now a Substance Use Disorder?
« Reply #3 on: April 19, 2022, 06:24:18 am »
This is why "physical dependence" is better than dependence.

I also thought so at first, but not if they use "physical dependence" and "psychological dependence" to mean just the two sub-categories of "substance dependence".

Like the APA, The International Classification of Diseases also classifies "substance dependence" as a "mental and behavioural disorder."

So this begs the obvious question of whether still using these "redefined" terms is akin to signing up to be diagnosed with a mental disease.

If they insist that having withdrawal symptoms from prescribed medications taken as directed is not a substance use disorder, but that having physical dependence is part of a substance use disorder, then it would seem to be wrong to use that term of dependence when talking about prescribed medications taken as directed.

I actually agree that having extremely severe withdrawal symptoms from prescribed medications is not a disorder (not a problem with the patient). But is it not a type of a drug injury (a problem with the drug)?
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: "dependence" is now a Substance Use Disorder?
« Reply #4 on: April 20, 2022, 07:04:07 pm »
This is why "physical dependence" is better than dependence.

I also thought so at first, but not if they use "physical dependence" and "psychological dependence" to mean just the two sub-categories of "substance dependence".

Like the APA, The International Classification of Diseases also classifies "substance dependence" as a "mental and behavioural disorder."

So this begs the obvious question of whether still using these "redefined" terms is akin to signing up to be diagnosed with a mental disease.

If they insist that having withdrawal symptoms from prescribed medications taken as directed is not a substance use disorder, but that having physical dependence is part of a substance use disorder, then it would seem to be wrong to use that term of dependence when talking about prescribed medications taken as directed.

I actually agree that having extremely severe withdrawal symptoms from prescribed medications is not a disorder (not a problem with the patient). But is it not a type of a drug injury (a problem with the drug)?

The DSM stuff is talked about a bit in this blog:

https://www.madinamerica.com/2015/11/language-surrounding-benzodiazepines/

I think it's neurological damage.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: "dependence" is now a Substance Use Disorder?
« Reply #5 on: April 21, 2022, 05:52:14 am »

The DSM stuff is talked about a bit in this blog:

https://www.madinamerica.com/2015/11/language-surrounding-benzodiazepines/

I think it's neurological damage.

Thank you for the link. That 2015 article was a detailed analysis of how using "addiction" incorrectly conflates "dependence." Part II provides possible solutions to that problem (https://www.madinamerica.com/2015/11/language-surrounding-benzodiazepines-part-ii/).

But like you, I'm looking outside the box, since both words now seem officially to fall under same "disease" category in their manuals. More importantly, both are inadequate word choices because both incorrectly point to the patient as the "guilty culprit" with a "need" for an innocent drug.

To more accurately describe reality, in the comments to part I & II of the article, the author agrees that calling it "damage" was more appropriate. Other comments also suggest:
- iatrogenic injury
- iatrogenic benzo damage
- iatrogenic poisoning
- neurological damage
- neurotoxicity
- neuropsychiatric damage/toxicity
- brain damage
- drug CNS damage
- physical and mental damage
What all these have in common is that they depict the source and direction of action from the drug onto the patient, pointing out the drug as the culprit inflicting an injury.
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[Buddie]

Re: "dependence" is now a Substance Use Disorder?
« Reply #6 on: April 22, 2022, 04:22:20 am »

The DSM stuff is talked about a bit in this blog:

https://www.madinamerica.com/2015/11/language-surrounding-benzodiazepines/

I think it's neurological damage.

Thank you for the link. That 2015 article was a detailed analysis of how using "addiction" incorrectly conflates "dependence." Part II provides possible solutions to that problem (https://www.madinamerica.com/2015/11/language-surrounding-benzodiazepines-part-ii/).

But like you, I'm looking outside the box, since both words now seem officially to fall under same "disease" category in their manuals. More importantly, both are inadequate word choices because both incorrectly point to the patient as the "guilty culprit" with a "need" for an innocent drug.

To more accurately describe reality, in the comments to part I & II of the article, the author agrees that calling it "damage" was more appropriate. Other comments also suggest:
- iatrogenic injury
- iatrogenic benzo damage
- iatrogenic poisoning
- neurological damage
- neurotoxicity
- neuropsychiatric damage/toxicity
- brain damage
- drug CNS damage
- physical and mental damage
What all these have in common is that they depict the source and direction of action from the drug onto the patient, pointing out the drug as the culprit inflicting an injury.

There's a new one coming out: Benzodiazepine Induced Neurological Dysfunction (BIND)
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[Buddie]

Re: "dependence" is now a Substance Use Disorder?
« Reply #7 on: April 23, 2022, 11:30:18 am »
This is why "physical dependence" is better than dependence.

I also thought so at first, but not if they use "physical dependence" and "psychological dependence" to mean just the two sub-categories of "substance dependence".

Like the APA, The International Classification of Diseases also classifies "substance dependence" as a "mental and behavioural disorder."

So this begs the obvious question of whether still using these "redefined" terms is akin to signing up to be diagnosed with a mental disease.

If they insist that having withdrawal symptoms from prescribed medications taken as directed is not a substance use disorder, but that having physical dependence is part of a substance use disorder, then it would seem to be wrong to use that term of dependence when talking about prescribed medications taken as directed.

I actually agree that having extremely severe withdrawal symptoms from prescribed medications is not a disorder (not a problem with the patient). But is it not a type of a drug injury (a problem with the drug)?

ABSOLUTELY it is an adverse drug experience!  That should be reported to FDA via the appropriate reporting mechanism - I think there is a link on the Benzo Coalition Information website for this.  Obviously this mechanism doesn't effectively serve its intended purpose.
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[Buddie]

Re: "dependence" is now a Substance Use Disorder?
« Reply #8 on: April 23, 2022, 08:00:30 pm »
I’m not on here much anymore, but I just saw this and wanted to comment.

The DSM has always been a subject of controversy. When a new version comes out, the controversy only increases.

Why? The pharmaceutical industry has a big influence on the changes that are made, and thus various and normal patterns of human behavior tend to be turned into a “medical problem” requiring more and more medications.

The reliability of the DSM 5 has been calculated to be about .2-.4% which is ridiculous in my opinion.

So, read it if you want, but as with most things in life, take it totally with a grain of salt. And in my opinion, if your doctor or therapist is hooked on this thing, take them with a grain of salt also.
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[Buddie]

Re: "dependence" is now a Substance Use Disorder?
« Reply #9 on: April 28, 2022, 02:04:42 am »
Thank you  [...], [...], [...] and [...], for your input, I tend to agree with you.  :thumbsup:

There's a new one coming out: Benzodiazepine Induced Neurological Dysfunction (BIND)

Regarding this new proposed term BIND, I don’t doubt the effort but here is my 2 cents. First, not sure for who’s use was the term developed (doctors or general public) and what was the intent behind forming the name (scientific accuracy or public awareness).

In my opinion, a successful name for “this thing” will be one that is most easily adopted and understood by the largest number of people. With this goal in mind, it should be fitting, simple, direct, descriptive, meaningful, straightforward and easy to grasp and memorize. Kind of like the terms used in the comments that I listed in my earlier post.

So, is Benzodiazepine Induced Neurological Dysfunction (BIND) not an
- unnecessarily long phrase
- words too big & complicated
- immediately clouding one’s mind
- with all four words too hard to memorize?

As far as the specific words go, isn’t
- Induced too soft of a word - from latin “inducere” or to “lead in”, it only hints at “initiating” or “bringing on” something that might have happened anyway (like inducing childbirth). It does not mean “caused” or “originated.”
 
- Dysfunction also too soft as it does not describe the harm caused to the victim.
Dysfunction also has a double meaning that can stereotype or stigmatize the patient - when used as a deviation from the norms of social behavior regarded as a bad fit, freakish, bizarre, defected, weird, deformed?

The above are just my initial thoughts if asked as a member of the public, trying to be constructive and supportive to help bring success to this naming effort.
« Last Edit: April 28, 2022, 02:30:54 am by [Buddie] »
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