Within the language of the mental health community, there are various terms which are used to describe issues that people often experience when they abuse a substance and/or exhibit compulsive behavior. Most are familiar with words like addiction and dependence, both of which can be interpreted and applied in a variety of ways. However, in the last couple of years, the standards have been redefined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which now classifies all instances of abuse and dependency as “substance-related and addictive disorders.”
This change is significant because, instead of diagnosing people as having dependence issues or substance abuse problems, they are now rating various criteria on a diagnostic spectrum, based on the initial diagnosis of a “substance use disorder” (SUD). Once it is determined what type of disorder the person is suffering from, the severity of the disorder is rated “mild,” “moderate,” or “severe.” There’s a set of 11 criteria with which to make these determinations, and if two or more are met, the diagnosis is SUD-Mild; with four or more, SUD-Moderate, and for six or more it’s SUD-Severe.
What is interesting about this new approach to diagnosing and treating substance use and addictive disorders is that it is more simplistic than the DSM-4 criteria, in many ways. At least it doesn’t divide diagnoses into two confusing categories of “substance abuse” and “substance dependence” as it did before. And it’s definitely an improvement over the previous approach to stigmatizing people as abusers or labeling them as drug dependent, yet there still seems to be something lacking.
For one thing, many of the criteria used for making a determination regarding substance use disorder are really vague. Some are also quite subjective, and would be open to interpretation without closely scrutinizing the meaning behind them and carefully defining the terms used. For example, one of the criteria is “You often take larger amounts of the drug over a longer period of time than you intended.” This statement could mean a variety of different things to anyone trying to interpret it, depending on whether they’re a professional offering treatment, a substance user seeking help, or a loved one giving support.
Then there’s the problem of the term “disorder” itself, which really seems like it would leave any diagnosis open to interpretation. The DSM-4 authors conceded that “different situations call for different definitions,” but the more current DSM-5 doesn’t seem to offer much more insight into what we should make of this word. The average medical dictionary simply defines the term as “a derangement or abnormality of function; a morbid physical or mental state,” which doesn’t really give us any greater clarity in regard to this term.
Another concern with this new methodology is the grouping of all substances into the category of “drugs.” Clearly, not all drugs are equal, especially when it comes to the list of items included in the Controlled Substance Act schedules. Some substances, such as heroin, cocaine, and alcohol, cause users to exhibit symptoms of addiction that can be very difficult to overcome, and cause some pretty severe withdrawal symptoms. However, the evidence that attempts to show that cannabis should be included with these other drugs, has never really been very convincing. In fact, the way that the DSM-5 describes withdrawal symptoms of cannabis use cessation, it seems that so-called “cannabis addiction” is no more significant than caffeine addiction.
Recent comparisons in scientific literature have been validating what many cannabis users have known for a long time now: cannabis use is much less risky than virtually all drug use, including alcohol. The average person today knows that alcohol is a toxic, and sometimes lethal substance that is nevertheless legal, so it’s therefore more socially acceptable and readily available than most other drugs, illegal or not. However, something many are not aware of is that caffeine is more addictive than cannabis. I know from personal experience that any sort of withdrawal symptoms that occur after quitting either caffeine or cannabis are actually far more intense with caffeine.
Caffeine withdrawal is actually noted in the DSM-5, but is sort of brushed off as another “Disorder of Interest.” They make sure to note that caffeine withdrawal is “marked by tiredness or sleepiness,” but the extreme headaches, body aches, irritability and restlessness involved are all strangely absent from their description. However, the description of cannabis withdrawal included all the same symptoms one would experience with caffeine withdrawal, and then some. And even though the subject of physiological cannabis addiction has remained controversial and unverifiable, it seems the authors of the DSM-5 have made the executive decision to include it as if it is very real and quite detrimental.
Soon, the truth will be known about cannabis, its benefits, and the lack of any real evidence of addictive qualities or detrimental effects that using it may bring about. This is not to say that there are no risks at all involved in using cannabis. That is largely dependent on how a person uses it, what strain is being used, and for what reasons it is being used. We clearly need a complete overhaul of drug policy, scientific scrutiny, and public discourse involving these things, so that cannabis can enjoy a more widely accepted and much more appropriate place alongside the most enjoyable and relatively benign substances like caffeine.