DSM V, RDoC and Diagnostic Approaches in Addiction Research and Therapy

Department of Psychiatry, University of British Columbia, Canada

*Corresponding Author:

Christian G. Schütz
Department of Psychiatry
University of British Columbia, Canada
Tel: 604 827 4362
Fax: 604 827 3373
E-mail: schutzc@mail.ubc.ca

Received June 22, 2012; Accepted June 23, 2012; Published June 25, 2012

Citation:Schütz CG (2012) DSM V, RDoC and Diagnostic Approaches in Addiction Research and Therapy. J Addict Res Ther 3:e107. doi:10.4172/2155-6105.1000e107

Copyright: © 2012 Schütz CG. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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The upcoming implementation of the Diagnostic and Statistical Manual (DSMV) has led to a renewed debate about current and future diagnostic approaches. Issues include discussing the pros and cons of categorical versus dimensional approaches and the related subject of descriptive versus causal diagnostic criteria. Traditionally, the DSM has focused on a “theory-free” descriptive diagnostic system, largely ignoring the fact that etiology is a core component of a disorder [1].

These concerns have been less central to addiction specialist. The issue of categorical versus dimensional approaches has led to little discussion, more so the issue of etiological factors underlying the “new” non-substance dependences (gambling, computer game). The new DSM V diagnostic entity “substance use disorder” eliminates the need to decide between the diagnosis of abuse or dependence, thus simplifying substance use disorder diagnosis [2].

The situation is different for other areas in the mental disorder field. A number of researchers have argued that DSM constitutes a roadblock for a better understanding of mental disorders [3]. They feel that scientific findings overall have had too little impact on the DSM. A discrepancy though can be made out between researchers and service providers. Researchers need an approach that is inviting to empirical calibration and readily adapts to new scientific knowledge. Service providers on the other hand need a diagnostic system that is stable, reliable, easy to apply, and informative for treatment.

The National Institute of Mental Health (NIMH) recently introduced the “research domains criteria” (RDoC) as a response to the shortcomings of the current diagnostic system. The RDoC include negative and positive valence systems, the arousal systems, as well as cognitive and social processes [4]. This approach is an attempt to “carve nature at its joints” and free research from the “roadblock DSM”. However, given the different needs of researchers and service providers, it is unlikely that service providers will readily embrace the new approach. Therefore, in order for the new approach to be successful, the RDoC and the DSM need to be used concurrently. This means for these approaches to be complementary it is pivotal to establish a structure that clarifies the link between these two systems.

The field of substance use disorder and addiction seems to be in an excellent position to play a leading role in this ongoing development. Addiction has a long history of well established preclinical neurobiological models, leading to a history of translational approaches. Additionally, the creation of a single diagnostic entity, “substance use disorder”, will make it relatively easy to link the single DSM diagnosis with the RDoC approaches. Finally, clinical research is already using approaches consistent with a dual DSM-RDoC approach.

Why should the addiction field embrace the RDoC approach? The RDoC approach is currently applied to mental disorders. But mental disorders and substance use disorders overlap massively. Aligning concepts and approaches from mental disorders will help addiction to be better integrated; allowing researchers to more easily study mechanisms underlying concurrent addiction and mental disorders and generalize findings. Moreover, a focus on cognitive, affective and behavioral mechanisms in general would help to support the value of clinical assessments. An added value is that the RDoC approach may bring research and clinicians closer, by focusing on clinical issues, (e.g. individual cognitive, affective and behavioral differences, the issue of concurrent disorder). Finally bringing mental disorders and substance use disorders conceptually closer may contribute to a reduction of stigma still hampering the field of substance use disorder. Thus it seems that the field of addiction could gain from deliberately adapting the RDoC and developing a structured approach to combine RDoc and DSM.

References

1. McHugh PR , Slavney PR (2012) Mental illness – comprehensive evaluation or checklist? N Engl J Med 366: 1853-1854.
2. American Psychiatric Association (2012) DSM-5: The Future of Psychiatric Diagnosis DSM-5 Development.
3. Van Praag HM (2010) Biological psychiatry: still marching forward in a dead end. World Psychiatry 9: 164-165.
4. Insel T, Cuthbert B, Garvey M, Heinssen R, Pine D, et al. (2010) Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry 167: 748-751.