1Prince of Songkla University, Hat Yai, Songkhla, Thailand
International classification and diagnostic systems need to respond to the different and often competing requirements of clinicians and epidemiologists for clinical diagnosis and disease monitoring respectively. This presentation will contrast the approach taken in ICD 11 development with that of DSM-5 but also identify areas of commonality and potential crosswalks.
The DSM-5, published in 2013 is centred on a broad and heterogeneous entity of substance use disorder, into which the earlier DSM-IV diagnoses of substance dependence and substance abuse have essentially been merged. Within substance use disorders, the DSM-IV recurrent substance-related legal problems criterion has been deleted from DSM-5, and a new criterion –craving, or a strong desire or urge to use a substance –has been added. The diagnosis of a substance use disorder is based on a pathological pattern of behaviours related to use of the substance, with criteria fitting into four groups, -impaired control, social impairment, risky use and pharmacological criteria. The 11th Revision of the ICD is at an advanced developmental stage. In the draft ICD 11 substance dependence is retained as the central diagnosis. The definition of harmful use of substances is proposed to include the damage to health caused through repeated episodes of intoxication, regular use of large amounts of a substance, or a harmful route of administration and also include the type of damage caused by instances of violence and self-harm when these require medical attention. More emphasis of substance dependence as a chronic disorder of regulation of psychoactive substance use, arising from repeated or continuous use of that substance is proposed. Characteristic features of substance dependence remain the same as those in ICD-10, including a strong drive to use the substance, impaired ability to control its use, increasing priority given to use over other activities, and often the development of tolerance and withdrawal symptoms, or continuing substance use to prevent or alleviate such symptoms.