What’s New in DSM-5 For Clinicians Working with Mandated Populations State Specialty Court Conference DuAne L. Young The Change Companies®

General Overview of the DSM-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

General Overview of the DSM-5 Most common diagnoses have minimal changes regarding core symptoms Some disorders are in new sections Personality Disorders remain the same

General Overview of the DSM-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

Allowing for Major Depressive Episode to be diagnosed while experiencing bereavement “Hot” topics

Disruptive Mood Deregulation Disorder – Essentially temper tantrums with persistent anger or irritability “Hot” topics

Asperger’s Disorder now encompassed in Autism Spectrum Disorders “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

Dependence may be substance specific The prognosis for dependence is different than for abuse

Substance Abuse

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

Substance Use Disorders 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

Substance Use Disorders 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 Scale 0–1 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

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