DSM-5 Substance Use Disorder Criteria Foster Stigma

February 26, 2020


The recognition of stigma embedded in diagnostic criteria for substance use disorders is the topic of an oped recently published in the BASIS. The DSM criteria for substance use largely ignores the internal experiences of individuals in favor of external factors such as employment, relationships and leisure activities. Mental disorders on the other hand focus primarily on the internal cognitive, emotional and physical experiences of the individual. The stigmatizing effect of this difference is evident in an article that was published in 2014. The authors examined public attitudes about mental illness and substance use disorders found substantial differences. Of the people surveyed, 78% were unwilling to work closely with someone who experiences substance use disorders, while only 38% said the same of a person with mental illness. Similarly, 90% of people were unwilling to have someone in the family marry someone with addiction and only 60% indicated that they would be unwilling to have someone with mental illness marry into their family. Conversely, when asked if they believe that discrimination is a serious problem; only 37% believed it was for substance use disorder and 62% believed it was for mental illness (Barry, McGinty, Pescosolido, & Goldman, 2014).  When we diagnose based on the lack of participation in previously enjoyed leisure activities or problems with employment, but don’t examine the lack of pleasure or work stress that a person is experiencing in their life; we are missing out on valuable information that can aid in clinical care.

Tanya Freedland, MPS, LADC is a Clinical Trainer and Research Associate at the Center for Practice Transformation at the University of Minnesota

Robert F. Krueger PhD is Distinguished McKnight University Professor in the Department of Psychology at the University of Minnesota.

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The BASIS is a product of the Division on Addiction, Cambridge Health Alliance, a Harvard Medical School teaching hospital.